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Med Surg 1 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Functions of the urinary and renal systems

A

Homeostasis
Regulate fluid and electrolytes
Antidiuretic made by the hypothalamus
Kidneys remove waste

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2
Q

The renal and urinary systems regulate the parathyroid hormone, what happens with hyper and hypothyroidism

A

Hyperthyroidism is associated with hypercalcemia (too much calcium in the blood) so they will try to remove the stones
Hypothyroidism is associated with hypocalcemia (calcium is pulled back into the bones so too little calcium in the blood) this leads to jerky movements and seizures

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3
Q

Too much ___ will cause hyper levels of potassium and sodium

A

Aldosterone

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4
Q

The kidney’s hat

A

Adrenals

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5
Q

Detrusor muscle that contracts to empty

A

Bladder

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6
Q

What is the total bladder capacity

A

1 liter

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7
Q

How much urine output should you have a day

A

1500 mL

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8
Q

Surrounds the male urethra

A

Prostate

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9
Q

What happens if a patient has hypotension

A

Angiotensinogen is released in the liver, then renin releases angiotensin 1, then a converting enzyme makes angiotensin 2 which increases the blood pressure

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10
Q

How to get urine for a urinalysis

A

Get their first void in the morning by clean catch

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11
Q

BUN and creatinine are diagnostic tests for..

A

Renal function

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12
Q

What does an ultrasonography let you see

A

Lets you see how much urine is left in the bladder after you pee

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13
Q

Stomach issues due to kidney problems

A

Renal colic

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14
Q

Interventions to help with diagnostic testing

A 
Usually increase fluid
Reduce discomfort/promote comfort
Administer analgesics and antispasmodics
Assess voiding patterns
Provide privacy and respect
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15
Q

In a 24 hour urine collection when should you collect

A

After the first pee

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16
Q

Inflamed bladder relating to a UTI

A

Cystitis

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17
Q

Common infection caused by e.coli/poop (the reason women are told to wipe from to back)

A

Urinary tract infection

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18
Q

In UTIs, greater than 100,000 bacteria means…

A

Infection

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19
Q

Women are more likely to get a UTI because…

A

Their urethra is much shorter

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20
Q

What are signs & symptoms of UTIs

A 
Urgency to urinate
Frequent urination
Burning sensation when urinating
Voiding small amounts of urine
Lower ab discomfort / back pain
Cloudy, dark, foul smelling urine
Hematuria (blood in the urine)
Chills, fever, nausea, vomiting
WBC found in urinalysis
Altered mental state in older adults
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21
Q

Interventions for UTIs

A

Increase fluids
Give meds
Apply heat the abdomen or sit down baths
Use sterile technique
Maintain closed drainage system for foley caths
Use 14 French size for foley cath
Drain the cath every 8 hours or when 2/3rds full
*Foley caths are very capable of causing nosocomial infections

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22
Q

Major infection that can lead to septic shock and is caused by a UTI (e.coli)
The body is trying to help the patient but its really just killing them
Disseminated intravascular coagulation (DIC) occurs meaning that proteins are hyperactively promoting clotting and cutting off circulation to organs
Looks like noblanching, big bruises
Pt will have an IV in the their abdomen

A

Urosepsis

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23
Q

An inflammation of the kidney often related to e.coli
A chronic condition results in obstructive flow issues
Signs and symptoms include: N/V, fever, chills, flank pain, CVA tenderness, dysuria, cloudy, blood in urine, foul smell

A

Pyelonephritis

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24
Q

Interventions for pyelonephritis

A 
Vital signs
Increase fluid to 3000 mL/day
Monitor intake and output
Monitor weight 
Get rest
High calorie/low protein diet (protein is hard for kidneys to manage)
Warm moist compress
Analgesics, antipyretics, antibiotics, antiemetics (for renal colic)
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25
Q

This is not a normal consequence of aging and can be controlled
May lead to an upper urinary system problem
Its under diagnosed and under reported

A

Urinary incontinence

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26
Q

Surprise sneeze, coughing, or laughing

Kegels help

A

Stress incontinence

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27
Q

An overactive detrusor muscle, so it contracts a lot makes you want to pee

A

Urge incontinence

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28
Q

This urinary incontinence can occur with medical diagnoses such as alzheimers

A

Functional incontinence

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29
Q

Urinary incontinence related to medicines that reduce blood pressure

A

Iatrogenic

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30
Q

What medications should be taken for incontinence

A

Anticholinergics (fight or flight)

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31
Q

When you cant empty that bladder completely so you have residual urine (the amount left in the bladder)
Causes might be age, diabetes, prostate enlargement, pregnancy, neurologic disorders, medications

A

Urinary retention

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32
Q

Measures to promote voiding

A

Running water
Privacy
Sit up (reverse trendelenburg)
Warm compress

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33
Q

Calculi (stones) in the urinary system

A

Urolithiasis

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34
Q

Calculi (stones) in the kidneys

A

Nephrolithiasis

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35
Q

What can cause stones

A

Family history of stone formation
Diet high in calcium, vitamin D, and protein
Lots of UTIs
Hyperparathyroidism

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36
Q

What occurs with stones

A 
Pain
Hematuria
Infection
Dull achy kidney pain
N/V
Fever
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37
Q

Interventions for urinary stones

A

Vital signs
Measure intake and output
Increase fluids
Ambulate

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38
Q

This is a medication for urinary infections and should be taken with a full glass of water
Ex.) ciprofloxacin

A

Fluoroquinolones

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39
Q

2nd leading cause of death
1.6 million diagnosed
Nearly 1 out of every 4 deaths
Highest in 65+ year old African American men

A

Cancer

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40
Q

These cells avoid normal cell growth regulating processes, warning signs, and defense mechanisms

A

Cancer cells

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41
Q

Substances that cause cancer: chemicals, physical, viruses and bacteria, genetics, dietary factors, hormones

A

Carcinogens

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42
Q

What is the process of a malignant transformation

A

Initiation: carcinogens mutate DNA
Promotion: repeated carcinogen exposure causes proliferation (growth)
Progression: angiogenesis and metastasizes

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43
Q

Chemical substances released to make new blood vessels that supply the cancer cells with blood to help them grow

A

Angiogenesis

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44
Q

Directly attempt to destruct the cancer cells and kill then

Also recruit B-cell lymphocytes with antibodies, natural killer cells, and macrophages to help kill cancer cells

A

T-cell lymphocytes

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45
Q

Cancer cells spread through..

A

Lymphatic circulation

Blood circulation

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46
Q

What are the 4 steps in diagnosing cancer

A

Determine the presence and extent of the cells
Has is metastasized?
Function of involved and uninvolved organs
Biopsy for analysis, staging, and grade

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47
Q

What are the stages of tumors, lymph involvement, and mets

A 
0- precancerous
1- limited to tissue of origin
2- limited to local tissue
3- extensive local and regional tissue spread
4- metastasis
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48
Q

How do you grade cancer cells

A

Grade 1- tumors cells closely resemble surrounding tissue

Grade 4- does not resemble surrounding tissue at all, poorly differentiated

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49
Q

Surgical treatments for cancer

A

Biopsy- remove small piece of tissue for lab to get stage and grade
Primary treatment: entire removal of tumor and surrounding tissue
Prophylactic surgery: removing organs at an increased risk for cancer
Palliative: to relieve discomforting symptoms happening because of cancer
Reconstructive: to improve cosmetic appearance (implants)

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50
Q

Can be curative, control, prophylactic, or palliative
Internal and external types
The dosage depends on how sensitive the cancer tissues are

A

Radiation

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51
Q

Side effects of radiation

A

Altered skin integrity, alopecia, stomatitis, dry mouth, anemia, fatigue, malaise, anorexia, leukopenia, thrombocytopenia (decrease in platelets, puts them at risk for bleeding)

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52
Q

Nursing management for temporary implantation of radiation therapy

A

Bed rest because you dont want them to dislodge it
Have a urinary catheter
Low residue diet (easy to digest)
No pregnant women in the room with them
Stay at least 6 ft back from the patient
Linen and trash should not leave room until OK’d with personnel because it could contain radiation
Same with urine and body fluids

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53
Q

Nursing management for external radiation

A 
Radiation site will be marked- dont want to rub/scrub/scratch that spot
Wear loose clothes
No heat or cold therapy
Limit sun exposure for at least a year
Oral care
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54
Q

Cure, control, or palliation
Antineoplastic drugs used to destroy cancer cells by interfering with cellular functions and DNA repair/replication
Repeated doses over a period of time to achieve regression or remission
Affects cells all over your body (systematic) rather than just the cancerous ones
Goal is to destroy cells
Monitor pulmonary and renal systems with this

A

Chemotherapy

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55
Q

Types of chemo

A 
Alkylating agents
Antimetabolites
Antitumor antibiotics
Hormonal agents
Plant alkaloids

Might have a combination of therapies and not just one

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56
Q

Mild irritation to severe necrosis

When chemo or IV cath is not in the right place and basically eats the skin

A

Extravasation

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57
Q

GI chemo toxicity causes…

A

N/V/D/

Inflammation

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58
Q

Hematopoietic chemo toxicity causes…

A

Anemias

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59
Q

Renal chemo toxicity causes…

A

Kidney failure

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60
Q

Cardiopulmonary chemo toxicity causes…

A

Heart failure & disease

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61
Q

Reproductive chemo toxicity causes…

A

Sterility

Affect testicular and ovarian functions

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62
Q

Neurological chemo toxicity causes…

A

Swelling of brain or nerves
Forgetful
Difficulty multitasking

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63
Q

Treatment of certain adult hematologic malignancies (treatment of blood cancers)

A

Bone marrow transplant

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64
Q

Types of bone marrow transplants

A

Allogeneic: from a family member or a matched donor
Autologous: from the patient, can harvest it from themselves before they start treatment
Syngeneic: from an identical twin

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65
Q

Donor cells try to kill the host cells
Patient can die from this
Immunosuppressants are prescribed to keep the cells from fighting each other
Increased risk occurs after first 100 days

A

Graft vs Host Disease

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66
Q 
For this impaired oral mucous membrane:
use a soft toothbrush
rinse 4 times a day with normal saline 
avoid spicy and hard to chew foods
keep hydrated
water soluble lip balm if lips become dry
no mouth washes, alcohol, or tobacco
assess mouth every shift
A

Stomatitis

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67
Q

What should you do for immunosuppressed patients (might be immunosuppressed due to graft vs. host disease which is occurs in bone marrow transplant patients who have blood cancers)

A

Vitals every 4 hours

Monitor labs and obtain cultures when infection is suspected

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68
Q

How to relieve nausea and vomiting

A 
Diet changes
Prevent unpleasant environments
Distract with music, self hypnosis, guided imagery, relaxation
Meds
Hydration
Pain relief
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69
Q

What should you do for nutrition altered patients (anorexia, malabsorption, cachexia (wasting away of the body due to chronic illness))

A 
Encourage foods that are well tolerated
Small but frequent meals
Encourage fluids
Relaxed, quiet environment
Nutritional supplements
Administer appetite stimulants
Might need enteral tube feeding
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70
Q

End stage illness nursing care

A

Hospice care

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71
Q

Types of urinary cancers

A

Renal cell carcinoma: most common, 90% of urinary cancers (usually a single tumor within the kidney)
Urothelial (transitional) carcinoma: rare only about 10% of cancers, line KUB, linked to smoking

Hematuria: sign of urinary cancer
They will remove mass on kidney or possibly the whole kidney itself

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72
Q

Rare, insulin dependent

A

Type 1 diabetes

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73
Q

When there is a higher risk for diabetes later in life

A

Gestational Diabetes

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74
Q

The presence of gestational diabetes can put babies at risk for macrosomia which is…

A

when the baby is born at a very large excessive weight

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75
Q

The roles of insulin

A

Transport and metabolize glucose into energy
Store glucose in the liver (need high levels of insulin for it to be converted to glycogen for later)
Store glycogen (carbs) in muscles for when its needed
Insulin also stores fat
Insulin stops the breakdown of glucose, protein, & fat so that it can move it into the cells

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76
Q

The body turns on itself and destroys the beta cells which make and store insulin
Usually have sugar in the urine (glucosuria)
Usually diagnosed when young

A

Type 1 diabetes

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77
Q

Whats a normal blood sugar

A

80-120

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78
Q

When they are glucose intolerant and arent dealing well with the sugars they are taking in making them hyperglycemic
Its treated with diet and exercise and if that doesnt work they give insulin
Usually obese, BMI greater than 25, and older than 45

A

Type 2 diabetes

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79
Q

What are the 3 P’s found in diabetes

A

Polyuria ( a lot of urine )
Polydipsia ( Thirsty )
Polyphagia ( Hungry )

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80
Q

What is going on when the patient is hot and dry

A

Their glucose is too high (hot and dry, blood sugar too high)

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81
Q

What is going on when the patient is cool and clammy

A

Their glucose is too low (cool and clammy, need some candy)

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82
Q

Clinical manifestations include fatigue, weakness, vision changes, numbness tingling, dry skin, recurrent infections, slow to heal wounds

A

Diabetes

83
Q

Diagnostic findings with diabetes

A

Fasting glucose greater or = to 126
Random glucose greater than 200 (do this one twice)
2 hours after eating (post prandial) and greater than 200
Hgb A1c greater than or equal to 6.5%

84
Q

The body turns carbohydrates into..

A

Glucose

85
Q

What is a good glycemic index for diabetes patients

A

You want a slow response so something 55 or less, slow response is good because its less of an impact on your blood sugar (a starch and a protein or fat)
Raw whole fruits are better for diabetics

86
Q

What do you want a diabetics plate to look like based on servings, carbs, fats, etc?

A

50-60% carbs
20-30% fats less saturated and less cholesterol
High fiber

87
Q

While exercising, blood sugar should be tested…

A

Before, in the middle, and after

88
Q

Morning blood sugar is too high because large amounts of sugar are released into the blood stream between 5-8 in the morning
Treat by pumping more insulin at dinner so levels dont get too high throughout the night

A

Dawn Phenomenon

89
Q

Morning blood sugar is too high because the body had too much insulin so hormones are released to counteract the low blood sugar
Treat by decreasing insulin at dinner to keep blood sugar from dropping too low in the middle of the night

A

Somoygi Effect

90
Q

What should diabetics be taught about their insulin

A

Know signs of hypo and hyperglycemia
Know how to monitor and check blood glucose levels
Insulin is injected subcutaneously usually in the abdomen
Teach about insulin pump

91
Q

Metformin (glucaphage) should not be given with CT dye and heart cath dye because it could cause..

A

Lactic acidosis, so metformin should be held 48 hours before and after CT or heart cath dye is given

92
Q

Reasons for becoming hypoglycemic

A

Too much insulin
Too much oral hypoglycemics
Not enough food
Too much exercise

93
Q

Side effects of hypoglycemia

A 
Palpitations
Tachycardia
Sweating
Tremors
Nervousness
Hunger
Cant concentrate
Headache
Double vision
Drowsy
Severe: seizures & unconsciousness
94
Q

How do you manage hypoglycemia

A 
15 in 15:
15 grams of fast acting carbs
-3 or 4 glucose tablets
-4oz of juice or soda
-6 to 10 hard candies
-2 to 3 teaspoons of honey

Retest blood sugar in 15 min and retreat if its still less than 70mg

95
Q

What should you do if a pt is hypoglycemic and unconscious or cant swallow

A

Inject 1mg glucagon subcutaneously or IM

then 25-50ml 50% dextrose solution IV

96
Q

This is when there is not enough insulin and so they patient is hyperglycemic, dehydrated, and experiencing acidosis (hyperventilating from too much CO2)
Ketones, which are acidic, build up in uncontrolled diabetes

A

Diabetic Ketoacidosis (DKA)

97
Q

What will you find with DKA

A 
a blood glucose of 300-800mg
a low pH with Kussmauls hyperventilation
Ketones in blood and urine
Acetone breath
polyuria and polydipsia
blurred vision
weakness
headache
N/V
abdominal pain
electrolytes will vary
98
Q

How do you treat DKA

A 
Rehydrate with IV fluids, they will also be hypokalemic (low potassium)
IV insulin to get blood sugar down
Reverse acidosis to restore electrolytes
Monitor renal functions I/O
EKG electrolyte levels
Vital signs and lung assessment
99
Q

High blood sugar (most frequently in type) that is not controlled
Dehydration is a big clue
Tachycardia and hypotension also relate
Has a high mortality

A

Hyperglycemic hyperosmolar nonketotic syndrome

100
Q

Long term complications of diabetes

A 
Macrovascular complications
-Atherosclerosis
-CAD
-PAD
-Stroke
Microvascular complications
-diabetic retinopathy (changes in back of eye)
-constipated
-unaware
-sexual dysfunction
-neuropathy (weakness,numbness,pain from nerve damage)
-neuropathic ulcers
101
Q

Ball & socket joints

A

Hip

Shoulder

102
Q

HInge joints

A

Elbow

Knee

103
Q

Saddle joints

A

Base of thumb

104
Q

Pivot joints

A

Radius
Ulna
Neck

105
Q

Gliding joints

A

Carpel bones in wrist

106
Q

Age related changes to the musculoskeletal system

A

Bones lose bone mass, they are more fragile, decrease in height because vertebral collapse
Muscles atrophy (shrink), less elastic, not as strong, decreased endurance
Joints deteriorate, vertebral discs thin, stiff reduced flexibility
Ligaments are weaker
Pain with ADLs

107
Q

The process of bone healing

A

Hematoma at the break
Tissue forms soft/short callus to keep it together
Replaced with denser/harder callus
Remodels for months or years to look like previous bone

108
Q 
Evaluates condition of joints
Contrast is injected into blood stream
ROM is performed to spread contrast
Xrays are taken during ROM
If a tear in present, contrast/dye will leak out the joint and be seen on the xray

NPO 8 hours before
Check for iodine & shellfish allergy, metal objects, and pregnancy
Wrap and perform RICE

A

Arthrography

109
Q

Dual xray to measure bone loss/bone density
Wrap and rest joint for 12 hours, strenuous activity should be avoided
Clicking or crackling is normal 24-48 hours after until contrast is fully absorbed
Check for iodine & shellfish allergy, metal objects, and pregnancy

A

Bone Densitometry

110
Q

Used to detect stage and evaluate bone cancers
Can detect stress fractures as well
Requires the injection of a radioisotope via IV
Scan is performed 2-3 hours after
An increased uptake of the isotope will be seen with bone diseases and nonhealing fractures
Drink fluids to flush out the radioisotope
Isotope allergy, metal, pregnancy?

A

Bone Scan

111
Q

Used to diagnose and treat acute and chronic joint diseases
Local or general anesthesia given in surgery
Biopsy can be performed
Treats tears and defects of joints
A large bore needle is inserted and joint is distended with saline
Joint structures visible with this instrument
Puncture the site closed with adhesive strips and sterile dressings
Compress with dressings for 2-4 days
Do neurovascular checks
Give pain meds
RICE
Limit physical activity and check non wt bearing status

A

Arthroscopy

112
Q

Aspiration of synovial fluid, blood, or pus for either examination or for pain relief
This is helpful is diagnosing septic arthritis, bleeding in the joint cavity, and other inflammatory diseases
Synovial fluid is usually a pale straw color
Insert the needle into the joint and aspirate fluid
Sterile dressing used after
Hair may need to be trimmed before, pain meds, and ice for 2 days after
May need antibiotics, watch for infection and swelling

A

Arthrocentesis

113
Q

Evaluates muscle weakness, pain, and disability
Determines abnormal functions or extent of nerve damage
Needle electrodes are inserted into the muscles
Electrical stimuli responses are recorded on paper
Assess anticoagulants because you want those stopped because you are stabbing their muscles and that could cause bleeding
No lotions or creams the day of
No stimulants or sedatives before because we don’t want them excitable but we don’t want them too relaxed
NSAIDs can be given for pain

A

Electromyography

114
Q

Determines specific disease from the tissues

Elevate, provide ice and pain meds

A

Bone/muscle biopsy

115
Q

Overstretching, over using, or excessive stress on muscle or tendon
Rated mild to severe
Treated with RICE, NSAIDS
Check neurovascular status

A

Strains

116
Q

Twisting motion, or hyperextension causing injury to ligaments and tendons
Rated mild to severe
Treated with RICE, NSAIDS
Check neurovascular status

A

Sprain

117
Q

Incomplete dislocation

A

Subluxation

118
Q

Complete separation of joint surfaces
Orthopedic emergency if traumatic
If pressure is not released, complication of avascular necrosis can occur (due to ischemia of joint structure, vessels, and nerves causing cell death)
Joints will first be immobilized, then put back in place, then splinted, casted, and put into traction

A

Dislocations

119
Q

Promotes vasoconstriction which decreases pain, edema, and discomfort

A

Cold therapy

120
Q

The bone is broken into 2 completely separate parts

A

Complete fracture

121
Q

Bone is splintered, crushed fragments

A

Comminuted fracture

122
Q

Bone is compressed by another bone (vertebral fracture)

A

Compression fracture

123
Q

One side of the bone is broken, the other side is bent
Doesnt go all the way across, just about half way
Seen more in kids

A

Greenstick fracture

124
Q

Bone driven into another bone

A

Impacted fracture

125
Q

Fracture at angle across the bone

A

Oblique fracture

126
Q

Bone is exposed through skin

A

Open/compound fracture

127
Q

Fracture twists around the bone

A

Spiral

128
Q

Fracture from repeated stress of bone or muscle, from sports, or running

A

Stress fracture

129
Q

Fracture straight across the bone shaft

A

Transverse

130
Q

Light weight, strong, water resistant, durable, dries within 30 minutes but difficult to mold

A

Fiberglass cast

131
Q

Cheaper, better mold, heavy, not water resistant, takes 3 days to dry

A

Plaster cast

132
Q

Provides support, controls movement, prevents more injury

Custom fitted, used long term, variety of materials

A

Braces

133
Q

Simple, stabalizes fractures, sprains, and tendon injuries

Easy to apply and remove

A

Splints

134
Q

What are the 5 P’s of neurovascular compromise

A 
Pain
Pallor
Pulse
Paresthesia (abnormal sensations)
Paralysis
135
Q

Used to manage and provide stability for complex open fractures with soft tissue damage, to correct defects, and lengthen limbs
Surgical pins are through the skin, soft tissue, and into the bone
Elevate the extremity
Any sharp points/pins should be covered
Neuro assessment every 2 hours
Assess pins for infection and inflammation

A

External fixator

136
Q

A pulling force to promote and maintain alignment to an injured area
Goal is to decrease muscle spasms and pain, realign, correct and prevent deformities
Use for short term until external or internal fixation is possible
Check ropes to make sure they aren’t frayed and make sure weights aren’t touching the ground and they are hanging freely
Neuro status
Pain meds
Inspect skin and pin site

A

Traction

137
Q

Purulent drainage is..

A

brown

138
Q

Serous drainage is..

A

clear

139
Q

Considered skin traction to the lower leg
Used to immobilize femur and hip before surgery
Inspect skin, neuro assessment
Clean and dry extremity before putting foam boot on
5-8 lb weight not touching the floor

A

Buck’s traction

140
Q

Usually after a long bone or pelvic fx and crush injuries
Manifestations- crackles, wheezes, chest pain, cough, thick white sputum, tachycardia, delirium, pulmonary edema, ARDS, resp. failure

A

Fat emolism

141
Q

Serious complication that can be limb threatening
Occurs when there is increased pressure within a confined space that limits blood flow and inadequate oxygenation occurs in the extremities
Can be caused by tight casts or constricting splints
Has a dusky pale appearance, cool, delayed cap refill, paresthesia, tightness, throbbing, very painful
Notify surgeon stat
Maintain elevation BUT NOT ABOVE THE HEART
Cut cast off to relieve pressure
Fasciotomy will be done for pressure over 8

A

Compartment syndrome

142
Q

Surgical removal of an unhealthy joint

A

Joint arthroplasty

143
Q

Patients are placed on a pressure relieving mattress, abductor splint, or 2-3 pillows between legs, hip never flexed more than 90 degrees, use high seated chairs, raised toilet seats, no crossing your legs, no turning leg inward, and avoid bending forward in a chair, ambulate with walker one day after surgery, ice therapy, foley, PT, and dressing changes

A

Total hip arthroplasty (THA)

144
Q

In post op the knee has compression dressings with ice therapy, neuro assessment every 2-4 hours, may have hemavac, drains, foley, dressing changes, continuous passive range of motion device for 6-8 hours, ambulate with walker 1 day after surgery

A

Total knee arthroplasty (TKA)

145
Q

When a disc moves out of place

A

Herniates

146
Q

Avoid abduction, external rotation, flexion, and sitting for long periods
Complications include hemorrhage (escape of blood from ruptured blood vessels), infection, skin breakdown, joint contracture, phantom limb pain

A

Amputation

147
Q

Reduce bone mass, deterioration of bone matrix, diminished bone strength, bones become porous and brittle, development of kyphosis, loss of height, occurs in women after menopause and in men later in life, if they need more calcium give it in 2 doses because the body can only handle so much calcium

A

Osteoporosis

148
Q

First line treatment for osteoporosis

A

Calcium and vitamin D supplements together

149
Q

Calcium and vitamin D supplements should not be taken with..

A

Biphosphonates (should be taken on an empty stomach in the morning with a full glass of water, sit up for 30-60 min after)

150
Q

Osteoporosis interventions

A 
Diet rich in calcium and vitamin D
Regular weight bearing exercises w/good body mechanics
Safe environment
2-3 side rails up
Cut out alcohol, coffee, and soda
151
Q

Softening and weakening of bones due to failed calcium absorption, calcium loss, vitamin D deficiency, malabsorption from GI disorders, prolonged antiseizure meds, hyperparathyroidism
Seen in kid’s with rickets disease
Painful, tender to touch, bowing of bones, fracture, skeletal deformities, waddling gait

A

Osteomalacia

152
Q

Infection of bone resulting in inflammation, necrosis, and formation of new bone due to blood infection, open trauma, vascular insufficiency
Staph aureus seen in 50% of bone infections

A

Osteomyelitis

153
Q

Heel pain with the first steps in the morning

A

Plantar fasciitis

154
Q

Overgrowth of layer of epidermis from pressure, a 5th toe

A

Corn

155
Q

Abnormally high arch, claw looking

A

Pes cavus

156
Q

Swelling of lateral branch of median plantar nerve, throbbing, burning pain relieved with rest and massage

A

Morton’s neuroma

157
Q

Flat foot, diminished arch

A

Pes planus

158
Q

Cranial nerve 2 is for..

A

Visual acuity

159
Q

Cranial nerve 3 is for..

A

Cardinal fields of gaze

160
Q

Can be indicative of a brain bleed after trauma

A

Different pupil sizes

161
Q

The ishahara chart is for..

A

Color vision testing

162
Q

When the eyes are going back and forth rhythmically

A

Nystagmus

163
Q

A droopy eye lid that may be from a stroke or TIA

A

Ptosis

164
Q

Normal vision is referred to as

A

emmetropia

165
Q

Nearsighted

A

Myopia (can see near, but not far)

166
Q

Farsighted, aging can cause farsightedness too

A

Hyperopia

167
Q

Age related far sightedness

A

Presbyopia

168
Q

Distortion due to irregularity of the cornea, not balanced or even

A

Astigmatism

169
Q

Increased IOP causing damage to the nerve
(IOP is worse in the mornings)
Congested areas between iris and cornea
Risk factors can be: family history, thin cornea, multiple surgeries on cornea, blacks, older, diabetes patients, cardiovascular disease, near sighted, trauma, long use of corticosteroids which can also cause cataracts

A

Glaucoma

170
Q

IOP is over 21mmHg
Happens over long periods of time
Chronic
“Silent thief” creeps up on you
Have peripheral vision loss (tunnel vision)
Blurring, halos, difficulty focusing, difficulty adjusting eyes to low light
Aching around eyes or headaches

A

Open angle

171
Q

Pupillary block glaucoma

Rare, painful, happens suddenly, lots of pressure

A

Angle closure

172
Q

Measures tone or pressure of the eye

A

Tonometry

173
Q

Measures how well things are flowing in the eye

A

Gonioscopy

174
Q

Assesses vision loss around perimeter of the eye

A

Perimetry

175
Q

There is no cure for this, just try to reduce amount of damage

A

Glaucoma

176
Q

These meds will help the patient relax and make the pupils smaller to allow for more flow around the eye

A

Beta blockers: miotics

177
Q

Surgery that changes the flow of the eye, changes shape

A

Laser trabeculoplasty

178
Q

Surgery that makes a hole in the iris, made for an area for more flow and less pressure

A

Laser iridotomy

179
Q

Surgery to take out some meshwork and make bigger riverbeds, more space, less pressure

A

Tribeculectomy

180
Q

Side effects of long term use are increased for infection, glaucoma, and cataracts

A

Topical steroids

NSAIDS or steroids can be used to reduce inflammation of glaucoma

181
Q

Opacity or cloudy lens
Produces disability, its painless, blurry vision, really sensitive to glare, reduced visual acuity, astigmatism, diplopia (double vision), color shifts
Can come with aging
Risk factors include smoking, long term use of corticosteroids, sunlight, radiation, DM, obesity, traumatic eye injuries

A

Cataracts

182
Q

Should have this surgery when the disorder starts interfering with ADLs
Done on outpatient base
Takes about an hour
Local anesthetic
Complications are rare but can be significant
Mydriatics to paralyze the eye
Dont sleep on bad side because its going to cause more pressure

A

Cataract surgery

183
Q

With cataract surgery, call surgeon if..

A

Pain is not decreased with acetaminophen
Redness
Drainage

184
Q

Shade or curtain coming from vision of one eye
Bright flashing lights
Sudden onset of floaters across vision
Separation of retina and retinal pigment epithelium

A

Retinal detachment

185
Q

Surgeries for retinal detachment

A

Sclera buckle
Pars plana vitrectomy (removal of vitreous)
Pneumatic retinopexy (injection of gas bubble, liquid, or oil to flatten) LIE BACK AND STILL, WANT RETINA TO FALL BACK INTO PLACE, NO LEANING FORWARD

186
Q

Kind of like cataracts
Central vision is bad, peripheral vision is great
Age related

A

Macular degeneration

187
Q

2 types of macular degeneration

A

Dry: slow break down of retina, yellow dots (drusen)
Wet: rapid onset, weird blood vessels grow under retina

188
Q

Age related macular degeneration interventions

A

Light sensitive verteporfin dye activated with a laser
Patient should avoid exposure to bright lights or sunlight for 5 days after treatment
Have better lighting and use magnification devices

189
Q

For eye trauma, we flush chemicals, but for foreign objects we should..

A

Cover the eye with a metal shield or paper cup

Dont remove object

190
Q

Patient has been through something awful, blind in one eye, but also in the other for no reason, usually with PTSD

A

Sympathetic opthalmia

191
Q

Classified by cause, VERY contagious
Bacterial infection will cause redness, discharge, and burning. Other than bacterial there is viral, fungal, parasitic, allergic, and toxic

A

Conjunctivitis (pink eye)

192
Q

This is in diabetics and leading cause of blindness among them

A

Diabetic retinopathy

193
Q

Can cause hemorrhage to the eye which is why you ask patients with high B/P if they have any vision issues

A

Hypertension

194
Q

Topical anesthetics end with

A

-caine

195
Q

These paralyze eye muscles but we dont want to use them on glaucoma patients because the pupil gets big

A

Mydriatics & Cycloplegics

196
Q

Different between inspection adult ear and 3 year olds ear

A

Adult: pull up and back
Child: pull down and back

197
Q

When adults can hear as they get much older
Risk factor is excessive noise
Early symptoms include tinnitus (ringing), increased inability to hear, turning up TV or radio, etc.
Its a gradual loss

A

Presbycusis (hearing loss)

198
Q

Hearing loss due to external or middle ear problem

A

Conductive

199
Q

Hearing loss due to damage to nerve or cochlea

A

Sensorineural

200
Q

Hearing loss due to emotional problems

A

Functional

201
Q

Bacterial or fungal infection of the ear
Pain and tenderness, discharge, edema, erythema, itching, hearing loss, feeling of fullness
Wick insertion will keep it open
EXTERNAL EAR ISSUE

A

External otitis (swimmers ear)

202
Q

Rare progressive ear infection that affects canal and surrounding brain tissue
EXTERNAL EAR ISSUE

A

malignant external otitis

203
Q

Inner ear fluid imbalance
Too much pressure, impacts nerves in the same way glaucoma impacts eyes
High risk for trauma and falling with all inner ear issues
Treat by reducing salt, reducing fluids (diuretics)

A

Meniere’s Disease

Med Surg 1 (4 decks)

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