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Adult care 2 > Exam 3 > Flashcards

Exam 3 Flashcards

(108 cards)

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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
S/s detached retina
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
26
Nursing care for detached retina
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.
27
Teaching for pt with gas bubble
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
28
Gas bubble-detached retina
Inserted to float over detached area and pushes it back against back of eye.
29
Macular degeneration
Two forms: wet and dry (more common) forms Deterioration of the macula (part of the retina at back of eye)= central loss of vision
30
Macular degeneration S/S
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
31
Dry form-macular degeneration
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
32
Wet (neovascular exudates)-macular degeneration
Blood or serum leak from newly formed vessels beneath retina moving macula(quick deterioration and damage to macula)=scar formation and visual problems
33
Client education for macular degeneration
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
34
Diet and supplements-macular degernation
Zinc oxide 80 mgm Cupric oxide 2 mg Beta carotene 15 mgm Vitamin C 500 mgm Vitamin E 400 IU
35
Drugs that risk hearing loss
Aminoglycoside antibiotics (Mycin)- ototoxic Antineoplastics (ICS platinum)- ototoxic Loop diuretics (furosemide)-ototoxic Propranolol (inderal)-tinnitus and hearing loss ASA and NSAIDs-tinnitus
36
Communication with elder adult with hearing loss
Speak clearly and at a normal pace without over exaggerating lip movements. Eye contact, face them head on
37
Care of hearing aids
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
38
Asthma
Narrowing/constriction of the bronchioles; alveoli not effected; “reactive airway”
39
Asthma causes
Allergic reactions- modifiable and nonmodifiable
40
Modifiable asthma causes
Smoking, exercise, occupational dust and chemicals, indoor and outdoor pollution
41
Nonmodifiable asthma causes
Allergies, genes, age, Aa deficiency
42
Pink puffer
Emphysema
43
Blue bloater
Chronic bronchitis
44
COPD is
Both emphysema and chronic bronchitis
45
Chronic bronchitis is AKA
Blue bloaters
46
Emphysema is AKA
Pink puffer
47
Chronic bronchitis
Entire respiratory tract is covered in mucous which is a barrier to gas exchange
48
Emphysema
Enlarged alveoli and CO2 retention
49
S/s chronic bronchitis
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
S/s emphysema
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
Pulmonary rehabilitation
Improves exercise intolerance and overall QOL -breathing -relaxation techniques -smoking cessation -energy conservation -exercise -group support
52
Management of exacerbations-asthma
Rescue inhaler/ nebulizer (albuterol), oxygen administration, anti-inflammatory- ICS
53
Management of exacerbations-COPD
SABA, ICS, oxygen therapy
54
Oxygen therapy considerations and safety
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
Client education-COPD
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
Client education-emphysema
Purse lipped breathing to blow off CO2, increased caloric needs, high calorie and high protein diet, oxygen use, CPAP use
57
Client education-asthma
Take ICS daily, albuterol=rescue drug. Rinse mouth after ICS. Report white tongue and oral mucous membranes
58
Rescue inhalers vs maintenance therapy
Rescue inhalers=SABA-albuterol Maintenance-LABA and ICS inhalers
59
Rescue inhalers
SABA-albuterol, should be used less than twice a week
60
Maintenance therapy-inhalers
LABA- long acting beta agonists Inhaled corticosteroid inhalers, anti-inflammatory ex
61
Assessment criteria-elder abuse
Repeated injuries, bruises and grip marks, repeat ER visits, refusal to go to same ER, fractures/breaks, hygiene deficit
62
Interventions-elder abuse
63
Types of elder abuse
Physical, emotional, financial, neglect
64
Usual victim and abuser in elder abuse
Usual victim: elder parent, white Caucasian elder woman, elder with dementia/confusion, elder unable to take care of self
65
What increases the risks for elder abuse?
Caregiver stress, family situations, caregiver personal situations, financial strain, sandwich generation
66
Role of nurse in elder abuse
REPORT-MANDATED! Interview elder and caregiver SEPARATELY -provide resources for caregiver respite care, support
67
Normal aging changes-memory
Forget where you put things(keys, wallet, phone, etc)
68
S/s dementia
Two cognate functions significantly impaired: - memory -communication and language -attention span limited -reasoning and judgement -visual perception
69
Mini-cog
Screening tool with three item recall and clock drawing test. Unsuccessful recall of three items after clock drawing distractor=probable dementia
70
BCAT
Brief cognitive assessment tool- determines level of cognitive impairment not dementia severity (delirium/confusion)
71
S/s depression
72
Differences in s/s of dementia vs depression
73
FAST score-Alzheimer’s disease
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
Alzheimer’s stages
Early-mid, moderate, late
75
Early stages-Alzheimer’s
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
Moderate stages- Alzheimer’s
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
Late stages-Alzheimer’s
All speech is lost, lose urinary and bowel control, cannot walk, bedridden, cannot swallow or speak-need constant care
78
7M’s of Alzheimer’s disease
Middle stage: Memory, movement, mental health,maintain safety
79
Interventions for early stage Alzheimer’s
80
Interventions for moderate state Alzheimer’s-memory
-Reorient and remind, remain patient, keep simple, do not scold
81
Interventions for moderate state Alzheimer’s-movement
-Independent as allowed, routines, exercise, fun games
82
Interventions for moderate state Alzheimer’s- mental health
-calm, distract, no hurry, hallucinations, limit outside noise, well-lit room, remove reflective times
83
Interventions for moderate Alzheimer’s stage-maintain safety
-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
Interventions for late stage Alzheimer’s
85
Alzheimer’s drugs
86
When Alzheimer’s drugs are used in the progression of the disease
87
Management of behavioral problems with Dementia
88
How do you best communicate with someone with dementia
89
Management strategies for aggression/agitation- dementia
Redirect/refocus Identify what they are communicating with you-hungry, bathroom, tired, etc
90
Physical problems/medications that can make dementia symptoms worse
Anticholinergics, HTN/cardiac drugs, chemotherapeutics,
91
Vascular dementia
Caused by block/interruption of bloodflow to brain
92
Sundowning
Worsening progression of confusion, behavior issues at night, wandering, hallucinations, agitation Triggers: exhaustion, sickness, new med, low exposure to sunlight
93
Sundowning interventions
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
Respite care
Someone else takes care of elder for a few hours a couple days a week to allow caregiver a break, temporary LTC placement
95
Stress and impact on the lay caregivers
Can lead to neglect/abuse
96
Interventions to help lay caregivers
Respite care, support groups
97
Paperwork needed to be a caregiver
98
Tool for care giver strain
99
How to use/administer tool for care giver strain
100
“Test” for depression
Geriatric depression scale (short=15, long=30). Score of five or higher indicates high risk for depression, needs further evaluation.
101
Is depression ever normal
No. More common in older adults. Risk increases when functional ability decreases
102
Medications used to treat depression
SSRI
103
Apraxia
Inability to perform certain motor movements (brush teeth)
104
Aphasia
Can’t understand speech or create it (pictures help)
105
Agnosia
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
Amnesia
Memory loss-cannot recall memories, who they are, birthday, address, etc
107
Anomia
Cannot recall name of objects. Know what it is, but can’t name it
108

Adult care 2 (5 decks)

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