exam 4 Flashcards
1
Q
Mild Pain & Gradual loss of peripheral vision (tunnel vision)
A
Open Angle Glaucoma
2
Q
Sudden/Severe/ Extreme Eye Pain [Medical Emergency]
A
Closed Angle Glaucoma
3
Q
African American, Age 60+, Corticosteroids
A
At risk: glaucoma
4
Q
[Halos around light, Headache, Eye Pain, Blurred Vision]
A
S&S glaucoma
5
Q
Dx: Tonometry Test (Normal IOP 10-21 mmHg) >21 HIGH
A
Glaucoma- Nursing Assessment
6
Q
Surgery: Laser Trabeculoplasty-Stabilize the optic nerve
Peripheral Iridotomy- Drainage implants/shunts
Pt needs to avoid coughing, sneezing, bending, Valsalva maneuvers, lifting, anticholinergics, Benadryl meds, wear sunglasses, during surgery 1 eye is tx at a time.
A
Glaucoma- Medical Treatment
7
Q
Beta Blockers (Timolol)- DO NOT give to a pt with asthma or bradycardia, lowest dose 1st until you reach desired levels.
Mannitol (Osmotic Diuretic)-Increase outflow to reduce IOP
Pilocarpine: Causes HEADACHE
Atropine- Dilates Pupils ½ hrs before eye exam. Causes Constriction
A
Glaucoma meds
7
Q
DO NOT give to a pt with asthma or bradycardia, lowest dose 1st until you reach desired levels.
A
Beta Blockers (Timolol) glaucoma
8
Q
Increase outflow to reduce IOP
A
Mannitol (Osmotic Diuretic) glaucoma
9
Q
Causes HEADACHE
A
Pilocarpine glaucoma
10
Q
Dilates Pupils ½ hrs before eye exam. Causes Constriction
A
Atropine glaucoma
11
Q
Hold pressure over tear duct for 3-5 mins
A
Nasolacrimal Occlusion (glaucoma)
12
Q
Causes photobia wear sunglasses after, no driving after eye dilation exam, exam q1-2yrs
A
glaucoma Teaching
13
Q
shake drops 1st, tilt head back, index finger to hold down lower lid conjunctiva, 15 mins before putting in contacts. Wait 5-10 minutes between eyedropsPilocarpine- Solution and gel Rx, eye drops 1st then after 5-10mins gel drops Drops are for daytime, Ointments are for night
A
glaucoma med admin
14
Q
“Cloud over lens leading to
blurry vison r/t aging”
[behind iris]
A
Cataracts
15
Q
“Increased Pressure within
the eye” [optic nerve issue]
front of eye
peripheral vision (tunnel
vision)
A
Glaucoma
16
Q
Smoking,
Obesity
Diabetes
Not wearing Sunglasses/ sun exposure
advanced age (65+)
A
Cataracts Risks
17
Q
Blurry vision
Astigmatism
Myopic shift-can’t see close
Sensitivity to light
Poor night vision
Color Changes
Halo
Diplopia (Double vision)
A
S&S cataracts
18
Q
CBC, ECG, Urinalysis, Hx
A
Pre Op check
19
Q
Phacoemulsification-Most common “IOL Implants”. Small opening in eye to reach clouded lens, laser breaks lens to pieces, suction fragments, inserts new lens replacement
Pre Op- CBC, ECG, Urinalysis, Hx
**MD needs to know if pt has taken Tamsulosin “Flomax” it
can cause intraoperative floppy disk syndrome.
A
Surgical Nursing Management
20
Q
Wear eye shield at bedtime for 1 week, ABT, Tylenol
monitor for increase in IOP.
A
Post Op teaching
21
Q
progressive eye disease wherein the central portion of the retina gradually deteriorates
“ Central vision changes r/t age, macular damage that
effects the retina”
A
Macular Degeneration
22
Q
Genetics
older age.
presence of AMD in the other eye.
family history of AMD.
smoking.
hypertension.
BMI of 30 kg/m2 or higher.
diet low in omega 3 and 6, vitamins, carotenoid and minerals.
diet high in fat.
A
Macular Degeneration risks
23
Q
tiny, yellowish spots called drusen beneath the retina
A
Macular Degeneration
24
Dark spots in central visions, Straight lines look curved, color less vivid.
Macular Degeneration s/s
25
Abrupt onset- S&S: more damaging vision, words broke, straight lines curved
Tx: Injection of medication Ranibizumab into eye (Vasoproliferation Ranibizumab “Lucentis”)
blood vessel leaks into retina causing swelling, bleeding into retina causing sudden or gradual vision loss
affects health of retina, metabolic product collects under retina causing gradual loss.
Slow break down
Tx: None
Macular Degeneration wet
26
unknown cause
Macular Degeneration dry
27
Teaching: Pt will do Amsler Grid at home they should monitor
for a sudden onset or distortion in vision. Look at Grid 1 eye at a time 7x a week. Change in Grid NOTIFY MD asap.
Medication: Dexamethasone-Decreases inflammation Corticosteroid Ophthalmic Drug Adverse effects: Conjunctive Iritis
Macular Degeneration teaching and meds
28
Fever,
Headache,
Change in LOC,
Ecchymosis,
Increased IOP.
petechial rash
Meningitis s/s
29
Monitor labs 1. CBC w/ differential, Stool sample
Ct scan before lumbar puncture test- testing for CSF for infection-sterile procedure.
*Monitor for clear fluids coming from dressing after lumbar puncture and REPORT TO MD!
*+ Kernigs sign-lay on back cant straighten leg. REPORT TO MD! EMERGENCY!
*+ Brudinski sign- when neck is flexed, hips & knees fold up and come up. REPORT TO MD! EMERGENCY!
Meningitis monitor
30
Caused by viral & bacterial
Meningitis
31
Most Contagious- Cloudy fluid
Meningitis bacterial
32
Most common- Clear fluid
Meningitis viral
33
“inflammation of protective membranes covering brain & spinal cord”
Meningitis
34
Droplet Isolation FIRST PRIORITY for the 1st 24 hrs.
Blood culture 1st & Ct scan before lumbar puncture
Meningitis priority
35
Monitor for seizures and dehydration
EMERGECNY: pt has low BP give bolus IV normal saline to raise BP
Increase fluids 3,000ml in 24hrs, check sensations in lower extremities, quiet-dark room, antipyretics, protective eyewear, handwashing, avoid long periods of reading/computers. Report redness & irritation.
Meningitis Management
35
Bacterial IV abt broad spectrum, corticosteroids Dexamethasone before ABT
Meningitis Meds
36
Clots there are 5 DIFF TYPES (Most common)
Ischemic stroke
37
Bleeds
Hemorrhagic stroke
38
Trouble speaking, paralysis or numbness, problems seeing in one or both eyes, sudden severe headache, psychological things like depression, hostility, lack of cooperation etc..
stroke s/s
39
1st sign SUDDEN SEVERE HEADACHE
Hemorrhagic stroke s/s
40
caused by atherosclerosis clot
Thrombotic Stroke:
41
Hypertension
Lacunar strokes:
42
A fib- traveling mass/clot lodged in the
brain
Embolic Stroke
43
BE FAST
Face, speech, motor
stroke assessment
44
Dx: FIRST NON-CONTRAST CT SCAN <25 mins from the
time pt comes in ED
Labs:
INR 2-3
Platelet 150,000-450,000
Glucose 90-110
Stroke Screening
45
African American,
20-44yrs
35-64yrs dying from stroke
Transient Ischemic Accident (TIA) Risk Factors
46
1st sign SEVERE HEADACHE
Change in LOC, N/V, weakness/numbness, seizures, loss of balance, dizzy, problems w/ speech & swallowing
Hemorrhagic Stroke
47
interventions: Mobility & preventing joint deformities, prevent
contractures, good alignments, nutrition, bowel and bladder
Stable Pts only!
Delegation of Tasks to LPN
48
Most common cause is aneurysm from high blood pressure
Carotid artery- protein build up in smaller vessels in brain,
75yrs+.
Precautions: BEDREST!!!!
No straining, bedrest/lay down!
Elevate HOB 15-30 degrees
Hemorrhagic Stroke- Nursing Management
49
if bleeding is caused by anticoagulation (warfarin) INR may be
corrected w/ fresh-frozen plasma and vitamin k
Bed rest, SCD/s, Tylenol, Accucheck, Cooling blankets, Hemodialysis.
Treatment of Stroke
50
- Vitamin K-reverse bleeding INR levels greater than 5 (too much warfarin)
Hemorrhagic stroke meds
51
Warfarin/Coumadin INR 2-3, do not use w/ patients’ w/ creatinine clearance of less than 15 ml/min
TIA- aspirin/ clopidogrel
Statins reduce cholesterol Antihypertensives “ACE” Lowers BP
Antidote= aminocaproic acid
Thrombolytic
Therapy- t-PA to be given within 60 minutes of the pt arriving to the ED, initiation within 3 hours
ischemic stroke meds
52
Smoking,
Socioeconomic disparities,
genetics,
radiation,
exposure to sunlight,
industrial chemicals,
asbestos,
obesity,
diet,
hormonal imbalance
cancer risk factors
53
reducing risks
HPV vaccine
immunizations
Maintain healthy weight, exercise, limit sitting & lying down for long periods, limit processed & red meats, ear veggies & fruits daily, limit alcohol to 1 drink per day, whole grains.
Primary Cancer Prevention
54
screening & early detection,
Secondary Cancer Prevention
55
monitoring and preventing recurrence of the primary cancer
survivors are assessed for the development of second malignancies such as lymphoma & leukemia
Tertiary cancer prevention
56
What does the American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention, say?
1 Achieve & Maintain a Healthy Weight Throughout Life
2 Adopt a Physically Active Lifestyle
3 Consume a Healthy Diet, W/ an Emphasis on Plant Sources
4 If You Drink Alcoholic Beverages, Limit Consumption 5Community Action
57
Woman should undergo regular screening mammography starting @ 45.
Woman ages 45-54 should be screened annually
Woman should have the opportunity to start being screened @ 40-44.
Screenings for Women
58
Men should have a prostate exam for ages over 50.
men cancer screening
59
Complete eradication of malignant disease (cure)
Prolonged survival & containment of cancer cell growth (control)
Relief of symptoms associated w/ the disease & improvement of
quality of life (palliation)
cancer treatment- surgery
60
assesses pt responses to Sx & monitors the pt for possible complications, such as infection, bleeding, thrombophlebitis, wound dehiscence, fluid & electrolyte imbalance, & organ dysfunction.
Post op cancer surgery
61
lead to (Burkitt lymphoma & nasopharyngeal cancer)
Epstein-Barr virus (EBV)
62
lead to (liver cancer)
Hepatitis B virus (HBV)
63
lead to (cervical & head & neck cancers)
Human papillomavirus (HPV)
64
Physical factors associated w/ carcinogenesis include:
Exposure to sunlight
Radiation
Chronic irritation or inflammation
Tobacco carcinogens
Industrial chemicals & asbestos
Genetics & Familial Factors
Lifestyle factors, such as diet, obesity, & insufficient physical activity.
Hormonal Agents
Cancer- Risk Factors
65
N/V, which may persist for 24 to 48 hours; delayed N/V may occur up to one wk after administration.
chemo side effects gi
66
cause some degree of myelosuppression (depression of bone marrow function), resulting in decreased WBCs (leukopenia), granulocytes (neutropenia), red blood cells (RBCs) (anemia), and platelets (thrombocytopenia) & increased risk of infection & bleeding
chemo side effects Hematopoietic System
67
Some chemotherapy agents damage the kidneys because they impair water secretion
chemo side effects renal
68
Several agents are associated with cardiac toxicity
chemo side effects cardiopulmonary
69
Testicular and ovarian function can be affected by chemotherapeutic agents, resulting in possible sterility.
chemo side effects reproductive system
70
fatigue
chemo side effects general
70
*vesicant*
Peripheral administration is limited to short duration (less than 1 hour; IV push or bolus) infusions using only a soft, plastic catheter placed in the forearm area.
Continuous infusion of vesicants that takes longer than 1 hour or are given frequently are given only via a central line, such as a right atrial Silastic catheter, implanted venous access device, or PICC
chemo admin considerations
71
infection
thrombosis
reaction
*If extravasation is suspected, the med administration is stopped immediately*
chemo admin Complications
72
Absence of blood return from the IV catheter
Resistance to flow of IV fluid
Burning or pain, swelling, or redness at the site
Indications of extravasation during administration of vesicant agents
73
Abnormalities in senses of taste, smell, and touch
Abnormal balance, tremors, or weakness
Cardiovascular toxicity (coronary artery disease, myocardial
infarction, congestive heart failure, valvular heart disease,
peripheral arterial disease)
Dental caries
Dry mouth
Dysphagia
Dyspnea on exertion
Herpes infections (zoster and varicella)
Hypothyroidism
Infertility
Osteoporosis
Pericarditis (acute or chronic)
Pneumococcal sepsis
Pneumonitis (acute or chronic)
Secondary cancers
Long-Term Chemotherapy Effects
74
Acute myeloid leukemia
Myelodysplastic syndromes
Non-Hodgkin lymphoma
Solid tumors (especially bone and soft tissue, lung, breast)
Thyroid cancer
Thymic hyperplasia
Secondary cancers: from chemo
74
aims to optimize “quality of life by anticipating, preventing & Tx suffering”
Palliative care
75
focuses on quality of life, & by necessity, it usually includes realistic emotional, social, spiritual, & financial preparation for death.
Hospice care
76
Hospital, Skilled Nursing Facilities & Outpatient
palliative care Setting
77
enable the pt to remain at home, surrounded by the people & objects that have been important to him or her throughout life.
goal of hospice
78
vary depending on the program, but generally pts must have a progressive, irreversible illness & limited life expectancy & must opt for palliative care rather than cure-focused Tx.
usually 6 months to live
hospice eligibility
79
states a pt's wishes for Tx.
Advanced Directives
80
appoints another person to make medical
decisions on behalf of the pt & is added to the advance directive.
proxy directive
81
legal document through which the signer appoints & authorizes another individual to make medical decisions on their behalf when he or she is no longer able to speak for himself or herself.
Durable power of attorney
*This is also known as a health care power of attorney, medical power of attorney, or a proxy directive.
82
a type of advance directive in which the individual documents Tx preferences.
It provides instructions for care in the event that the signer is terminally ill & not able to communicate their wishes directly & often is accompanied by a durable power of attorney for health care.
living will
*This is also known as a medical directive or Tx directive.
83
nurse could establish eye contact & follow with a statement acknowledging the patient's fears (“This must be very difficult for you”) & an open-ended statement or question (“Tell me more about what is on your mind”).
In response to the question “Am I dying?”
84
Resist the impulse to fill the “empty space” in communication w/
talk.
Allow the pt and the family sufficient time to reflect & respond
after asking a question.
Prompt gently: “Do you need more time to think about this?”
Avoid distractions (noise, interruptions).
Avoid the impulse to give advice.
Avoid canned responses: “I know just how you feel.”
Ask questions.
Assess understanding—your own & the pt’s—by restating,
summarizing, & reviewing.
Keys to effective listening include the following:
85
The neuroleptic drug haloperidol (Haldol) is the most frequently used drug to treat delirium in palliative care settings and may reduce hallucinations and agitation at the end of life.
Benzodiazepines (e.g., lorazepam [Ativan]) can reduce anxiety but may contribute to worsening cognitive impairment if used alone.
Terminally Ill Patient meds
86
nurse should consult w/the interprofessional team about discontinuing measures that no longer contribute to pt comfort, such as drawing blood, administering tube feedings, suctioning (in most cases), & invasive monitoring.
Nursing Care of Patients Who Are Close To Death (comfort care)
87
made through a physical examination that includes auscultation for the absence of breathing & heart sounds.
determination of death
88
The lethal tumor dose is defined as the dose that will eradicate 95% of the tumor yet preserve normal tissue.
Radiation Dosage
89
the total radiation dose is delivered over several wks in daily doses called fractions. This allows healthy tissue to repair and achieves greater cell kill by exposing more cells to the radiation as they begin active cell division.
In external-beam radiation therapy (EBRT)
90
allow for the periphery of the tumor to be reoxygenated repeatedly, because tumors shrink from the outside inward. This increases the radiosensitivity of the tumor, thereby increasing tumor cell death
Repeated radiation Tx over time (fractionated doses)
91
widely used form of systemic brachytherapy that is the primary Tx for thyroid cancer
Radioactive iodine (I-131)
92
selectively targets prostate cancer bone metastases w/ high-energy, short-range alpha particles & is approved for the Tx of pts w/ symptomatic bone metastases & no known visceral metastatic disease
Radium-223 dichloride
93
used as a form of radioimmunotherapy for the Tx of refractory non-Hodgkin lymphoma.
Radioisotopes
94
UTI’s
Cardiac dysrhythmias (ventricular ectopy, tachycardia, & heart blocks), Complications of immobility
Hyperglycemia has been associated w/ poor neurologic outcomes in acute stroke, therefore blood glucose should be in the range of 140 to 180 mg/dL.
complications after a stroke
95
Amsler grids are given to pts to use in their homes to monitor for a sudden onset or distortion of vision
Macular Degeneration- Patient Education
96
