Exam I Flashcards
Age related near vision loss is called _____?
presbyopia
Age related hearing loss is called _____?
presbycusis
Tactile perception declines at a rate of __% per year between the ages of 20 and 80.
1%
What are the individual risk factors that affect sensory perception ?
- Medications
- Medical conditions
- Lifestyle choices
- Occupation
_____ disturbances are among the most common adverse side effects associated with medication therapy
visual
These include blurred vision, papillary constriction, retinal toxicity, halo effects, and dry eyes
_____ is an adverse medication effect on the ears that can cause permanent or temporary problems with the inner ear that can affect not only hearing, but balance and speech
Ototoxicity
Drugs that affect taste and smell are primarily used for _____?
Chemotherapy
Alterations in taste and smell result in … ?
- Chemotherapy
- Poor nutrition
- Food enjoyment
- Quality of life
Drugs that cause taste disturbances include… ?
- Anti-microbials
- Anti-virals
- Anti-hypertensives
- Calcium Channel Blockers
- Diuretics
_____ is numbing/tingling in the hands and feet
Parasthesia
Drugs that can cause parasthesia include… ?
- Anti-neoplastic
- Anti-convulsants
Which medical conditions can cause visual disturbances?
- Brain tumors
- Cancer
- Head injuries
- Infectious diseases
- Stroke
- Cardiovascular disease (i.e. hypertension, CVAs)
Which medical conditions can alter smell and taste?
- Upper respiratory tract infections
- Sinus infections
- Seasonal allergies
- Dental problems
Which medical conditions can cause neurological disturbances?
- CVAs
- Stroke
- Autism
What lifestyle choices can cause alterations in sensory perception?
- Smoking (taste, smell)
- Constant exposure to loud noise (auditory)
Which cranial nerves are involved in vision?
- II (optic)
- III (occulomotor)
- IV (trochlear)
- V (trigeminal)
- VI (abducens)
Which cranial nerves are involved in hearing?
- VIII (acoustic)
- IX (glossopharyngeal)
- X (vagus)
Which cranial nerves are involved with taste and speech?
- V (trigeminal)
- VII (facial)
- IX (glossopharyngeal)
- XII (Hypoglossal)
Which cranial nerves are involved in smell?
- I (olfactory)
A _____ spinal cord injury is one in which the spinal cord has been damaged in a way that eliminates all innervation below the level of the injury
Complete
A _____ spinal cord injury is one that allows some function or movement below the level of the injury
Incomplete
What are the five PRIMARY mechanisms that may result in spinal cord injury?
- hyperflexation
- hyperextension
- axial loading or vertical compression
- excessive rotation
- penetrating trauma
_____ occurs when the head is suddenly and forcefully accelerated forward. It can also be called whiplash
Hyperflexation
May damage the spinal cord, causing hemorrhage, edema, and necrosis. Caused by head-on car crash
_____ occurs when the head is suddenly accelerated and then decelerated, it goes forward, then back.
Hyperextension
The spinal cord may be damaged. This stretches or tears the anterior longitudinal ligament, fractures or subluxates the vertebrae, and perhaps ruptures an intervertebral disk. Caused by a rear-end car crash
A secondary injury is one that worsens the primary injury. Examples of secondary injuries include…
- hemorrhage
- ischemia
- hypovolemia
- impaired tissue perfusion from neurologic shock
- local edema
A _____ into the spinal cord may be manifested in contusion or petechial leaking into the central gray matter and later into white matter
Hemorrhage
_____ or _____ involves the paralysis of all four limbs
Tetraplegia or Quadriplegia
_____ is weakness involving all four extremities
Quadriparesis
_____ is paralysis of the lower extremities while _____ is weakness in the lower extremities
Paraplegia, paraparesis
_____ is decreased sensation
Hypoesthesia
_____ is increased sensation
Hyperesthesia
What are the three conditions that may occur because of loss of sympathetic input?
- bradycardia
- hypotension
- hypothermia
What are the psychosocial consequences of visual impairment?
- Learning difficulties
- Depression
- Anxiety
- Loss of self-worth
- Difficulty with interpersonal relationships
What are the psychosocial consequences of hearing impairment?
- Difficulty with interpersonal relationships
- Learning difficulties
- Isolation
- Frustration
- Work difficulties
What are the psychosocial consequences of taste/smell impairment?
Overall quality of life
What are the pharmacological therapies for vision impairment?
- Beta andrenergic
- Prostaglandin analogs
- Adrenergic agonists
- Carbonic anhydrase inhibitors
- Antimicrobials
- Steroids
- Analgesics
What are the pharmacological therapies for hearing impairment?
- Antimicroials
- Steroids
- Analgesics
What information is important to collect regarding medical history in a patient with a spinal cord injury?
- History of osteoporosis
- History of arthritis of the spine
- History of congenital deformities
- History of cancer
- Previous injury/surgery of neck or back
Respiratory compromise is a risk when cervical spinal nerves _____ are damaged?
C3-5
These innervate the phrenic nerve, which controls the diaphragm
Air in the chest cavity is called _____?
Pneumothorax
Blood in the chest cavity is called _____?
Hemothorax
A patient with complete but temporary loss of motor, sensory, reflex, and autonomic function is experiencing _______
Spinal shock
This often lasts less than 48 hours but may last several weeks
______ is decreased sensation
Hypoesthesia
_____ is increased sensation
Hyperesthesia
Loss of sympathetic input as a result of the spinal cord injury causes these physical symptoms; _____, _____, & _____
- Bradycardia
- Hypotension
- Hypothermia
These changes can lead to cardiac dysrhythmias and a systolic blood pressure below 90 requires treatment due to lack of perfusion
Lack of sympathetic or hypothalamic control causes a patient to lose ________ functions
Thermoregulatory
Obstruction of the intestine due to paralysis of the intestinal muscle is called…
Paralytic ileus
This may develop within 72 hours of hospital admission
Bony overgrowth, often into the muscle, which is a complication of immobility is called…
Heterotopic ossification (HO)
Assess for swelling redness, warmth, and decreased range of motion.
The hip is the most common place where a heterotopic ossification occurs
This is a potentially life-threatening problem that results from the disruption in the communication pathways between upper motor neurons and lower motor neurons
Neurogenic shock
Signs and symptoms typically appear within 24 hours after injury and are most common in patients with injuries above T6
Patients with acute spinal cord injury should be assessed hourly for these unfavorable responses which are typical with neurogenic shock
- Airway and pulse ox <90
- Bardycardia
- Decreased LOC
- Decreased urine output
- Hypotension (systolic <90)
Treatment includes fluids and vasopressor
What are common causes of autonomic dysreflexia (causing bradycardia and a sudden rise in BP)?
- Bladder distention
- UTI
- Epdidymitis/Scrotal compression
- Bowel distention/Constipation/Hemorrhoids
- Pain
- Tight clothing
- Temperature fluctuations
What are the signs and symptoms of autonomic dysreflexia?
- sudden rise in blood pressure with bradycardia
- profuse sweating especially in face, neck, shoulders
- goosebumps
- flushing of the skin especially in the face, neck, shoulders
- blurred vision/spots in visual field
- nasal congestion
- Quick onset of severe, throbbing headache
What are the emergency interventions for a patient experiencing autonomic dysreflexia?
- placed patient in sitting position. This is the first priority!
- notify healthcare provider
- assess for and treat cause
- check for urinary/catheter blockage or constipation/impaction
- monitor blood pressure every 10 to 15 minutes
- give nifedipine or nitrate as prescribed
Men with spinal cord injuries above _____ are often able to have erections by stimulating reflex activity (i.e. Stroking)
T6
This type of injury appears on the front of the spinal cord. Symptoms include loss of pain and temperature below the point of injury, light touch sensation is maintained, disc herniation possible as well as atherosclerosis
Anterior cord syndrome
This type of injury appears on the back of the spinal cord and is caused by herniation, trauma, heavy lifting
Posterior cord syndrome
This type of injury presents with ipsilateral paralysis. Pain and temperature are preserved but sensation is opposite
Brown-Sequard Syndrome
With this type of injury effects the central part of the spinal cord. Usually secondary to herniation or penetrating trauma
Central cord syndrome
Which areas of the spinal cord are found at the clavicle level?
C3-C4
Which area of the spinal cord is found at the nipple line?
T4
Which area of the spinal cord is found at the ambilicus?
T10
This stage of Guillain-Barre syndrome last from 1 to 4 weeks and begins with the onset of the first symptoms and ends when deterioration stops
Acute/initial stage
This stage of Guillain-Barre syndrome lasts several days to 2 weeks and symptoms remain constant
The plateau phase
This stage of Guillain-Barre syndrome lasts 4-6 months and can continue up to 2 years.
The recovery phase
Which illnesses are associated with Guillain-Barre Syndrome?
- bacterial infection
- c-diff
- influenza
- Epstein-Barr
- cytomegalovirus (viral)
What tests are used to diagnose Guillian-Barre syndrome?
A lumbar puncture to evaluate cerebrospinal fluid. An increase in protein level can occur from inflammatory plasma proteins, myelin break down, and damaged nerve roots. High protein levels reach a peak by weeks 4-6
What is the treatment plan for Guillian-Barre Syndrome?
- Plasmapheresis, plasma is separated from whole blood, blood cells are returned without plasma
- Immunoglobulin therapy (IVIG), must be infused slowly to observe for complications which can include chills, fever, headache, anaphylaxis, aseptic meningitis, retinal necrosis, and acute renal failure
What is the most common area of the brain for tumors to occur?
Cerebral
- Increased intercranial pressure
- motor deficits increase
- impaired cognition
- neuro deficits
- eschemia
Where do primary brain tumors originate?
The CNS, these rarely metastasize
This type of tumor metastasizes and is often found in the brain?
Secondary tumors
What are the complications of cerebral tumors?
- cerebral edema
- ICP
- neurologic deficits
- hydrocephalus
- pituitary/endocrine dysfunction
What are the types of nonsurgical management of brain tumors?
- radiation therapy
- chemotherapy
- analgesics/opioids for headaches
- dexamethasone for ICP
- phenytoin for seizure control
- stereostatic radio surgery (direct gamma rays to tumor)
What are the surgical interventions for brain tumors?
Craniotomy
What is the pharmacological postop treatment for brain tumor/craniotomy?
- antilepileptic
- histamine blockers (swelling)
- dexamethasone (reduces ICP)
- opioids (pain)
What are post op complications with craniotomy?
- pneumonia
- pressure ulcers
- hematoma
- seizures
- CSF leak (presents with headache)
- fluid and electrolyte imbalance
What is the post op position for the bed with infratentorial brain surgery?
Flat bed for 24-48 hrs post op (side-lying)
Infratentorial= back of brain (brain stem & cerebellum)
What is the post op position for the bed with supratentorial brain surgery?
HOB at 30° for the first 24-48 hours
Supratentorial=front of the brain (cerebral hemisphere)
After craniotomy what is the period of time a patient is at risk for seizures?
Up to a year
What are the discharge instructions for a craniotomy patient?
- no bending over
- only moderate exercise
- no heavy lifting
What is the grade of a tumor with benign tissue, brain cells that look nearly normal, slow growing
Grade 1
What is the grade of a tumor with malignant tissue and slightly abnormal brain cells
Grade II
What is the grade of a tumor with malignant tissue, abnormal brain cells with active growth
Grade III
What is the grade of a tumor with malignant cells, brain cells are abnormal with quick growth
Grade IV
What are the signs and symptoms of brain tumor?
- headaches
- nausea and vomiting
- Visual symptoms
- seizures/convulsions
- facial numbness/tingling
- loss of balance/dizziness
- weakness/paralysis
- difficulty thinking, speaking, articulating
- Papilledema (swelling of the optic disc)
This type of tumor usually results in paralysis, seizures, memory loss, cognitive impairment, language impairment, or vision problems
Supratentorial (cerebral) tumors
This type of tumor produces ataxia, autonamic nervous system dysfunction, vomiting, drooling, hearing loss, and vision impairment. As the tumor grows, ICP increases as the symptoms become progressively more severe
Infratentorial tumors (brainstem)
What are the signs and symptoms of Infratentorial (brainstem) tumors?
- hearing loss
- Facial pain/weakness
- dysphasia/decreased gag reflex
- nystagmus
- hoarseness
- ataxia and dysarthria
What is the typical amount of drainage after brain surgery
30-50 mL/8 hrs
What is vertigo and what are its causes?
The feeling of space spinning around you
Causes:
- inner ear infection (labrynthitis)
- Ménière’s disease (propreoception)
- Acoustic neuromas (ear tumor)
- motion sickness
- drug/alcohol use
What is dizziness and what are its causes?
The feeling that you are spinning
Causes:
- decreased BP
- hypovolemia
- hypoglycemia
- medications
- drugs/alcohol
This eye disease presents with clouding and blurring of the lens and increased density due to the formation of fibers and crystals, with peripheral and night vision loss
Cataracts
What are the predisposing factors for cataracts?
- Age 65 or older
- congenital (born with condition)
- trauma
- exposure to toxins
- sun exposure
- diabetes
- medications (steroids, beta blockers, myotics )
What is the postop care for cataracts?
- antibiotics-steroids eye drops
- dark glasses
- educate regarding mild itching but minimal pain
- no lifting, leaning forward
- call dr with significant pain
- bloodshot eyes are expected
What are the symptoms of acute closed-angle glaucoma?
- hazy or blurred vision
- appearance of rainbow: colored circles around bright lights
- severe eye and head pain, brow pain
- nausea and/or vomiting
- sudden sight loss
- tonometry reading 30mmHg or higher (norm 10-21)
Glaucoma is generally age related, occurring in people older than _____
80
What are the two types of glaucoma?
Primary open angle and primary angle closure (acute glaucoma)
Which form of glaucoma is a medical emergency?
Acute Closed Angle glaucoma
What are the symptoms of open angle glaucoma?
- develops slowly
- mild aching in eyes
- seeing halos around lights
- decreased vision (peripheral)
- tonometry of 22-30mmHg (norm 10-21)
What is the pharmacological treatment for glaucoma?
- prostaglandin agonists
- adrenergic agonists
- Beta adrenergic blockers
- cholinergic agonist
- carbonic anhydrase inhibitors
This eye disease presents with mild blurring and visual distortion in the area of center vision. Gray or black dots may appear in the visual field
Macular degeneration
What are the risk factors for dry macular degeneration?
- short stature
- Asian
- smoker
- heart problems
- Family history
- for intake of vitamin E and carotene
What intervention is used to slow the progression of wet macular degeneration?
Vascular endothelial growth factor inhibitors (VEGFIs)
There is no cure, new blood vessel leak into the retina
This eye disease presents with fluid buildup in the layers of the cells under the retina. And scarring occurs and central vision becomes blurry until all vision is lost. There is no cure
Dry macular degeneration
This type of burn is painful, has redness, blanches with pressure and has no edema
Superficial
This type of burn is painful, moist and blistered
Partial Thickness
This type of burn is discolored, dry and has no pain
Full Thickness
This layer of skin has no blood vessels and can regenerate quickly
Epidermis
What are the three layers of the skin?
- Epidermis
- Dermis
- Subcutaneous tissue
What layer of skin is damaged by Superficial Burns and how long does this type of burn take to heal?
- Epidermis
- 3 to 6 days
What layer of skin is damaged by Superficial Partial-Thickness Burns and how long do they take to heal?
- Epidermis and part of the Dermis
- Uncomplicated healing occurs in 10-21 days
What layer of skin is damaged by Deep Partial-Thickness Burns and how long do they take to heal?
- Epidermis and deeper layers of the Dermis
- 2 to 6 weeks
Which layer of skin is damaged by Full-Thickness Burns and how long do they take to heal?
- Epidermis, Dermis and sometimes into the Subcutaneous Tissue
- The skin cannot heal from this type of burn on its own
- With treatment such as grafting takes weeks to months to heal
Which layer of skin is damaged by Deep Full-Thickness Burns and how long do they take to heal?
- Epidermis, Dermis, and Subcutaneous Tissue
- The skin cannot heal from this type of burn on its own
- With treatment such as grafting takes weeks to months to heal
Which type of burns are caused by sunburn or flash burn?
Superficial
Which types of burns are caused by sclalding, flames and brief contact with hot objects?
Superficial-Partial Thickness
Which type of burns are caused by scalding, flames, prolonged contact with hot objects, tar, grease and chemicals?
Deep-Partial Thickness Burns
Which type of burns are caused by scalding, flames, prolonged contact with hot objects, tar, grease, chemicals and electricity?
Full-Thickness Burns
Which type of burns are caused by prolonged exposure to flames, electricity, grease, tar, or chemicals?
Deep Full-Thickness Burns
Which types of burns exhibit no pain?
Deep-Full Thickness Burns (sometimes Full-Thickness)
Which types of burns create blisters?
Superficial-Partial Thickness Burns (rarely Deep-Partial Thickness Burns)
Which type of burns have soft and dry eschar?
Deep-Partial Thickness
Which type of burns have hard and inelastic eschar?
Full Thickness and Deep-Partial Thickness Burns
Which type of burn is considered 1st degree?
Superficial Burns
Which type of burn is considered 2nd degree?
Partial Thickness Burns
What are the critical physiological needs for the regrowth of skin cells?
- Adequate nutrition
- Adequate hydration
- Oxygenation
What are the phases of burn injuries?
- Resuscitation Phase
- Acute Phase (includes diuresis phase)
- Rehabilitation Phase
How long does the Resuscitation Phase last?
12-36 hours. This phase lasts until diuresis occurs and cell shifting begins to return to normal.
What are the primary interventions during the Resuscitation Phase?
- Secure airway
- Support circulation/Fluid replacement (no diuretics)
- Prevent Infection
- Maintain body temperature
- Provide emotional support
What are the physiological changes presenting during the Resuscitation Phase of a burn injury?
- Increased body weight d/t fluid shifting
- Hypovolemia d/t fluid shifting
- Metabolic Acidosis d/t potassium loss, fluid shifting
- Hyperkalemic d/t reduced kidney function
- Hyponatremic d/t fluid shifting
- Loud/Brassy cough with respiratory burns
What are the nursing interventions for burn patients with compromised respiratory function?
- Ensure patent airway
- Assist patient with sitting up
- Monitor pulse-ox
- Monitor lung sound
Which phase of burn recovery does diuresis take place?
The Acute Phase
Full diuresis occurs within 48-72 hours
When does a Curling’s Ulcer present and what are the treatments?
- May develop as early as 24 hours after a severe burn
- H2 histamine blockers & PPIs
When does diuresis occur after a burn and during which phase?
- 48 to 72 hours
- Acute Phase
What is the only change that occurs during diuresis?
Hypokalemia
Kidney function begins to return and potassium is returned to the cells
What labs are drawn to assess kidney function and what are the expected results with burn patients?
- Increased BUN (7-20 mg/dL)
- Creatinine (0.6 - 1.3 mg/dL)
- Sodium (135-145 mEq/L)
What type of fluids are used with burns and why?
Isotonic fluids to draw nutrients back into the cells
What is the protocol for fluid replacement therapy for the first 24 hours with a burn patient?
- 50% of total calculated fluids given in first 8 hours
- Other 50% given over next 16 hours
When does the Acute Stage of a burn injury occur and how long does it last?
The Acute Phase begins about 36-48 hours after injury
What are the nursing interventions during the acute phase?
- Airway
- Cardio Function
- Nutritional status
- Burn/Wound Care
- Pain control
- Psychosocial
What is the standard wound dressing for burns?
Vaseline covered gauze, wounds must stay moist
What type of biologic dressing is made of human skin and applied surgically?
Homograft
What type of biologic dressing is made of skin from another species and applied surgically?
Heterograft
What type of biologic dressing is grown from a small skin sample from the patient?
Cultured skin
What type of biologic dressing contains an epidermis and dermis made from beef collagen and shark cartilage?
Artificial Skin
What type of dressing is both biologic and synthetic?
Biosynthetic
How is cross contamination of wounds transmitted?
Person-to-Person
How is auto contamination of wounds transmitted?
from one part of the body to another
When does the Rehabilitation Phase of burn injury occur?
Begins with wound closure and ends when patient returns to highest possible level of function
What are the signs and symptoms of pulmonary injury from inhalation burns?
- Loud/Brassy cough
- Drooling
- Audible wheeze
What types are special care should be taken with burn patients?
- Isolation
- Use of aseptic technique
- Frequent and proper hand washing
- Limited visitation
What is the most significant allergic reaction to silver sulfadiazine (silvadene)?
Significant drop in white blood cells
What’s the difference between Broca’s Area and Wernicke’s Area?
- Broca’s Area controls production of speech (expressive aphasia)-frontal
- Wernicke’s Area controls comprehension (written/spoken)-temporal
What are the risk factors for glaucoma?
- familial
- over age 40
- diabetes
- HTN
- history of ocular problems
This eye disease causes a buildup up aqueous humor
Glaucoma
What are the causes of vertigo?
- Inner ear infection (labrynthitis)
- Ménière’s disease
- Acoustic neuroma
- Motion sickness
- Drugs/Alcohol
Which medications assist with Vertigo?
- Meclizine
- Valium
- Benedryl
- Dramamine
