Exam 3 Flashcards by Hannah Boaz

Functions of the urinary and renal systems

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

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

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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Too much ___ will cause hyper levels of potassium and sodium

Aldosterone

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The kidney’s hat

Adrenals

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Detrusor muscle that contracts to empty

Bladder

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What is the total bladder capacity

1 liter

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How much urine output should you have a day

1500 mL

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Surrounds the male urethra

Prostate

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What happens if a patient has hypotension

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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How to get urine for a urinalysis

Get their first void in the morning by clean catch

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BUN and creatinine are diagnostic tests for..

Renal function

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What does an ultrasonography let you see

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

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Stomach issues due to kidney problems

Renal colic

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Interventions to help with diagnostic testing

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

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In a 24 hour urine collection when should you collect

After the first pee

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Inflamed bladder relating to a UTI

Cystitis

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

Urinary tract infection

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In UTIs, greater than 100,000 bacteria means…

Infection

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Women are more likely to get a UTI because…

Their urethra is much shorter

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What are signs & symptoms of UTIs

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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Interventions for UTIs

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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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

Urosepsis

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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

Pyelonephritis

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Interventions for pyelonephritis

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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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

Urinary incontinence

Surprise sneeze, coughing, or laughing | Kegels help

Stress incontinence

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

Urge incontinence

This urinary incontinence can occur with medical diagnoses such as alzheimers

Functional incontinence

Urinary incontinence related to medicines that reduce blood pressure

Iatrogenic

What medications should be taken for incontinence

Anticholinergics (fight or flight)

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

Urinary retention

Measures to promote voiding

Running water Privacy Sit up (reverse trendelenburg) Warm compress

Calculi (stones) in the urinary system

Urolithiasis

Calculi (stones) in the kidneys

Nephrolithiasis

What can cause stones

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

What occurs with stones

``` Pain Hematuria Infection Dull achy kidney pain N/V Fever ```

Interventions for urinary stones

Vital signs Measure intake and output Increase fluids Ambulate

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

Fluoroquinolones

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

Cancer

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

Cancer cells

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

Carcinogens

What is the process of a malignant transformation

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

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

Angiogenesis

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

T-cell lymphocytes

Cancer cells spread through..

Lymphatic circulation | Blood circulation

What are the 4 steps in diagnosing cancer

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

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

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

How do you grade cancer cells

Grade 1- tumors cells closely resemble surrounding tissue | Grade 4- does not resemble surrounding tissue at all, poorly differentiated

Surgical treatments for cancer

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)

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

Radiation

Side effects of radiation

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

Nursing management for temporary implantation of radiation therapy

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

Nursing management for external radiation

``` 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 ```

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

Chemotherapy

Types of chemo

``` Alkylating agents Antimetabolites Antitumor antibiotics Hormonal agents Plant alkaloids ``` Might have a combination of therapies and not just one

Mild irritation to severe necrosis | When chemo or IV cath is not in the right place and basically eats the skin

Extravasation

GI chemo toxicity causes...

N/V/D/ | Inflammation

Hematopoietic chemo toxicity causes...

Anemias

Renal chemo toxicity causes...

Kidney failure

Cardiopulmonary chemo toxicity causes...

Heart failure & disease

Reproductive chemo toxicity causes...

Sterility | Affect testicular and ovarian functions

Neurological chemo toxicity causes...

Swelling of brain or nerves Forgetful Difficulty multitasking

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

Bone marrow transplant

Types of bone marrow transplants

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

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

Graft vs Host Disease

``` 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 ```

Stomatitis

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)

Vitals every 4 hours | Monitor labs and obtain cultures when infection is suspected

How to relieve nausea and vomiting

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

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

``` 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 ```

End stage illness nursing care

Hospice care

Types of urinary cancers

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

Rare, insulin dependent

Type 1 diabetes

When there is a higher risk for diabetes later in life

Gestational Diabetes

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

when the baby is born at a very large excessive weight

The roles of insulin

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

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

Type 1 diabetes

Whats a normal blood sugar

80-120

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

Type 2 diabetes

What are the 3 P's found in diabetes

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

What is going on when the patient is hot and dry

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

What is going on when the patient is cool and clammy

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

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

Diabetes

Diagnostic findings with diabetes

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%

The body turns carbohydrates into..

Glucose

What is a good glycemic index for diabetes patients

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

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

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

While exercising, blood sugar should be tested...

Before, in the middle, and after

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

Dawn Phenomenon

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

Somoygi Effect

What should diabetics be taught about their insulin

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

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

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

Reasons for becoming hypoglycemic

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

Side effects of hypoglycemia

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

How do you manage hypoglycemia

``` 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

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

Inject 1mg glucagon subcutaneously or IM | then 25-50ml 50% dextrose solution IV

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

Diabetic Ketoacidosis (DKA)

What will you find with DKA

``` 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 ```

How do you treat DKA

``` 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 ```

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

Hyperglycemic hyperosmolar nonketotic syndrome

Long term complications of diabetes

``` 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 ```

Ball & socket joints

Hip | Shoulder

HInge joints

Elbow | Knee

Saddle joints

Base of thumb

Pivot joints

Radius Ulna Neck

Gliding joints

Carpel bones in wrist

Age related changes to the musculoskeletal system

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

The process of bone healing

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

``` 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

Arthrography

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

Bone Densitometry

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?

Bone Scan

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

Arthroscopy

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

Arthrocentesis

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

Electromyography

Determines specific disease from the tissues | Elevate, provide ice and pain meds

Bone/muscle biopsy

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

Strains

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

Sprain

Incomplete dislocation

Subluxation

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

Dislocations

Promotes vasoconstriction which decreases pain, edema, and discomfort

Cold therapy

The bone is broken into 2 completely separate parts

Complete fracture

Bone is splintered, crushed fragments

Comminuted fracture

Bone is compressed by another bone (vertebral fracture)

Compression fracture

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

Greenstick fracture

Bone driven into another bone

Impacted fracture

Fracture at angle across the bone

Oblique fracture

Bone is exposed through skin

Open/compound fracture

Fracture twists around the bone

Spiral

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

Stress fracture

Fracture straight across the bone shaft

Transverse

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

Fiberglass cast

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

Plaster cast

Provides support, controls movement, prevents more injury | Custom fitted, used long term, variety of materials

Braces

Simple, stabalizes fractures, sprains, and tendon injuries | Easy to apply and remove

Splints

What are the 5 P's of neurovascular compromise

``` Pain Pallor Pulse Paresthesia (abnormal sensations) Paralysis ```

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

External fixator

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

Traction

Purulent drainage is..

brown

Serous drainage is..

clear

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

Buck's traction

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

Fat emolism

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

Compartment syndrome

Surgical removal of an unhealthy joint

Joint arthroplasty

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

Total hip arthroplasty (THA)

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

Total knee arthroplasty (TKA)

When a disc moves out of place

Herniates

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

Amputation

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

Osteoporosis

First line treatment for osteoporosis

Calcium and vitamin D supplements together

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

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

Osteoporosis interventions

``` 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 ```

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

Osteomalacia

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

Osteomyelitis

Heel pain with the first steps in the morning

Plantar fasciitis

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

Corn

Abnormally high arch, claw looking

Pes cavus

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

Morton's neuroma

Flat foot, diminished arch

Pes planus

Cranial nerve 2 is for..

Visual acuity

Cranial nerve 3 is for..

Cardinal fields of gaze

Can be indicative of a brain bleed after trauma

Different pupil sizes

The ishahara chart is for..

Color vision testing

When the eyes are going back and forth rhythmically

Nystagmus

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

Ptosis

Normal vision is referred to as

emmetropia

Nearsighted

Myopia (can see near, but not far)

Farsighted, aging can cause farsightedness too

Hyperopia

Age related far sightedness

Presbyopia

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

Astigmatism

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

Glaucoma

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

Open angle

Pupillary block glaucoma | Rare, painful, happens suddenly, lots of pressure

Angle closure

Measures tone or pressure of the eye

Tonometry

Measures how well things are flowing in the eye

Gonioscopy

Assesses vision loss around perimeter of the eye

Perimetry

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

Glaucoma

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

Beta blockers: miotics

Surgery that changes the flow of the eye, changes shape

Laser trabeculoplasty

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

Laser iridotomy

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

Tribeculectomy

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

Topical steroids | NSAIDS or steroids can be used to reduce inflammation of glaucoma

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

Cataracts

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

Cataract surgery

With cataract surgery, call surgeon if..

Pain is not decreased with acetaminophen Redness Drainage

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

Retinal detachment

Surgeries for retinal detachment

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

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

Macular degeneration

2 types of macular degeneration

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

Age related macular degeneration interventions

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

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

Cover the eye with a metal shield or paper cup | Dont remove object

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

Sympathetic opthalmia

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

Conjunctivitis (pink eye)

This is in diabetics and leading cause of blindness among them

Diabetic retinopathy

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

Hypertension

Topical anesthetics end with

-caine

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

Mydriatics & Cycloplegics

Different between inspection adult ear and 3 year olds ear

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

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

Presbycusis (hearing loss)

Hearing loss due to external or middle ear problem

Conductive

Hearing loss due to damage to nerve or cochlea

Sensorineural

Hearing loss due to emotional problems

Functional

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

External otitis (swimmers ear)

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

malignant external otitis

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)

Meniere's Disease