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Final Flashcards

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1
Q

What is emmetropia? Myopia? Hyperopia? Astigamatism?

A

Normal vision

Nearsighted and have blurred distance vision

Farsighted, have excellent distance vision but blurry near vision

Distortion due to curvature of the cornea

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2
Q

What is glaucoma? Cause? What is normal IOP? How often are the eye screenings?

A

damage to the optic nerve is related to increased intraocular pressure (IOP) caused by excessive aqueous humor/production and drainage are not in balance

Increased IOP causes irreversible mechanical and/or ischemic damage

Normal IOP is 10 to 21 mm Hg

Before age 40: every 2 to 4 years
40 to 54: every 1 to 3 years
55 to 64: every 1 to 2 years
65 and older: every 6 to 12 months

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3
Q

What does the angle refer to when distinguishing glaucoma? What is open-angle glaucoma/primary open angle? How does the IOP increase? Is it acute or gradual? S/S? Treatment?

A

angle between iris and cornea

Most common form
The aqueous humor outflow is decreased due to blockage in the drainage system

IOP increases due to reduced outflow of fluid

Gradual rise in IOP (22-32 mm Hg)
“Silent thief” of vision
Gradual loss of peripheral vision

Often initially asymptomatic, mild eye pain, blurry vision, halos around lights, and HA can occur

Requires chronic lifelong treatment

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4
Q

What is narrow-angle/primary-angle closure? Does IOP increase acutely or slowly? S/S? Treatment?

A

The angle suddenly closes, usually due to dilation of pupil

IOP increases suddenly (30 mm Hg or higher)

Severe eye pain, NV, photophobia, HA, decreased or blurry vision, colored halos around lights, red eyes, hazy cornea, pupils nonreactive to light

Requires immediate treatment to reduce IOP

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5
Q

What are nursing actions when administering eye drops? Why use punctal occlusion?

A

one drop in each eye twice daily

Wait 5 to 10 minutes between eye drops if more than one is prescribed

Avoid touching the tip of the applicator to the eye

Always wash hands before and after use

to insure the med does not go into the system.

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6
Q

What is first-line pharm therapy for both chronic and acute glaucoma? What is used for closed-angle specifically? MOA? SE? What are 3 other common meds?

A

Timolol (beta blocker)- first-line therapy, reduces fluid production
Drops can cause reduced BP, bradycardia, hypoglycemia, and bronchospasm

Pilocarpine (cholinergic)
Drops cause miosis of the pupil, used in closed-angle glaucoma
Can cause bradycardia and dizziness (low BP)

Apraclonidine (alpha-adrenergic agonist)
Acetazolamide (carbonic anhydrase inhibitor)
Iatanoprost (prostaglandin analogue)

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7
Q

What is the client teaching for glaucoma surgery?

A

Wear sunglasses

Report manifestations of infection

Avoid activities that increase IOP
Bending at the waist, sneezing, coughing, straining, head hyperflexion, restrictive clothing, sexual intercourse

Use stool softener daily (docusate)

Do not lift anything > 15 lbs.

Limit activities such as tilting the head back to wash hair, cooking, housekeeping, rapid/jerky movements (vacuuming), driving and operating heavy machinery, playing sports

Do not lie on operative side

Report severe pain or nausea as this can indicate possible hemorrhage

Final best vision occurs 4 to 6 weeks after surgery

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8
Q

What is cataracts? Common causes?

A

An opacity or cloudiness of the lens that impairs vision

Common causes: age-related, traumatic, toxic (meds such as corticosteroids), associated (DM, hypoparathyroid, chronic sun exposure), complicated (intraocular disease such as glaucoma or retinal detachment)

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9
Q

What are clinical manifestations of cateracts?

A

Painless and progressive, blurry vision
Reduced night vision
Sensitivity to glare of light
Reduced visual acuity
Prescription changes, reduced night vision, decreased color perception
Myopic shift (return of ability to do close work)
Diplopia in a single eye
Color shifts as lens becomes more brown
Opacity of the lens

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10
Q

What is client teaching for cataracts surgery?

A

Final best vision occurs 4 to 6 weeks after surgery
Protective eye patch for 24 hours
Eyeglasses during the day
Eye shield at night
Washing of hands
Cleaning of eye
Shampoo hair cautiously
Decrease intraocular pressure
Avoid lying on side of affected eye the night of surgery

Health promotion teaching:
Protective eyewear while playing sports, hazardous activities (yard work)
Encourage annual eye exams

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11
Q

What is retinal detachment? S/S?

A

Separation of the sensory retina and the retinal pigment epithelium (RPE)
Hole or tear develops in the retina
Liquid vitreous seeps through and causes the retina to detach

S/S
Sensation of a shade or curtain coming across the vision of one eye
Bright flashing lights
Sudden onset of floaters
This is a true ocular emergency!

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12
Q

What is macular degeneration? What accumulates in the retina? S/S? What is dry macular degeneration? Wet?

A

Central loss of vision that affects the macula of the eye

drusen: Clusters of debris or waste material
Tiny, yellowish spots beneath the retina

Lack of depth perception
Objects appear distorted
Blurred vision
Loss of central vision
Blindness

The most common type
Caused by gradual blockage in retinal capillary arteries  ischemia and necrosis

Caused by new growth of blood vessels of thin walls causing the vessels to leak blood and fluid

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13
Q

What is the treatment for macular degeneration? Client education on vitamins?

A

Laser therapy to seal leaking vessels
Ocular injections

Consume foods high in antioxidants, carotene, vitamin E, and B12
May be prescribed a supplement high in carotene and vitamin E

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14
Q

What is diabetic retinopathy? Early symptoms? Treatment?

A

damage to the blood vessels in the tissue at the back of the eye (retina) resulting in microaneurysms,ischemic retina, and hemorrhages

Floaters, blurriness, dark areas of vision, difficulty perceiving colors

Mild cases may be treated with careful diabetes management
Advanced cases may require laser treatment or surgery

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15
Q

What is enucleation? What two ways is it done?

A

Removal of the eyeball (globe) from the orbit
Evisceration-removal of contents through an incision
Exenteration-removal of entire contents

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16
Q

What is the purpose of the Weber test? How are ear conditions categorized? How is sound heard with each category?

A

Weber Test:used to establish a diagnosis in clients with unilateral hearing loss

Is it from the outer ear, eardrum, ossicles (conductive)or the nerves? (sensorineural)

Sensorineural hearing loss: sound is heard louder on the side of the intact ear

Conductive hearing loss: sound is heard louder on the side of the affected ear

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17
Q

What is Rinne test? What do the findings indicate?

A

Useful for distinguishing between conductive and sensorineural hearing loss- assesses both air and bone conduction of sound of affected ear

If no conductive problem like earwax, eardrum,ossicles, then sounds will be heard longer through air

If there is a conductive problem, then the bone vibration will last longer than through air

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18
Q

How is vertigo tested? How is it detected? How is it conducted? Nursing actions? Contraindication? What other test can be done concurrently and test for nystagmus?

A

Electronystagmography (ENG):used in vertigo testing

Detects involuntary eye movements (nystagmus)

Assess for disease of the vestibular system
Electrodes are taped near the eyes and recorded when the ear canal is stimulated with cold water instillation or injection of air

Keep the client alert during the procedures
Client should maintain bedrest and NPO until vertigo subsides
Fast before the procedure
Restrict caffeine, alcohol, sedatives, and antihistamines several days before the test

Contraindicated in clients with pacemakers (pacemaker signals inhibit sensitivity of ENG)

caloric test

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19
Q

What causes a conductive hearing issue? Sensorineural? Can you have both at the same time?

A

Due to external canal or middle ear problem
Often caused by otitis media, otosclerosis, and foreign bodies, ear wax

Sensorineural
Due to damage to the cochlea or vestibulocochlear nerve (CN VIII)

yes

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20
Q

What is otitis externa? Common causes? Manifestations?

A

Inflammation/infection (most commonly from bacteria or fungus) of the external auditory canal

Swimmer’s ear or trauma

Pain and tenderness
Pain with pulling on pinna of ear or pressing the tragus
Discharge- yellow/green/foul-smelling; fungal infections contain hairlike black spores
Edema of canal
Erythema of canal
Pruritus
Hearing loss
Feelings of fullness in the ear

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21
Q

What are causes of a tympanic membrane perforation? Is it self-limiting? What is the surgical intervention if needed?

A

Otitis media, nearby explosion, severe blow to ear, deep diving

Heal spontaneously in weeks to several months

Tympanoplasty
Tissue is placed across the perforation to allow healing and improves hearing

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22
Q

What is otorrhea? Rhinorrhea? Hemotympanum?

A

leakage of fluid from ear
CSF from the ear in a basal skull fracture, a clear, watery drainage

nasal fluid discharge
CSF from the nose, also in basal skull fracture

Blood behind the ear drum from trauma and basal skull fracture

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23
Q

What is acute otitis media? S/S?

A

Acute viral or bacterial infection of the middle ear

Otalgia (sensation of fullness or pain in ear)
Drainage from the ear (purulent or blood drainage)….only if TM perforation
Fever
Headache
Conductive hearing loss

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24
Q

What is serous otitis media? S/S? Treatment?

A

Middle ear effusion
Can occur following an acute otitis media
Fluid without infection

Hearing loss
Fullness or congestion
Popping or crackling noises as the eustachian tube attempts to open

May need a tympanostomy tube to drain

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25
What is a tympanoplasty? Ossiculoplasty?
reconstruction of tympani membrane reconstruction of middle ear bones with prostheses
26
What is a mastoidectomy? What is a cholesteatoma?
Removal of diseased bone, mastoid air cells, and cholesteatoma to create a non-infected, healthy ear Cholesteatoma: A benign tumor that is an ingrowth of skin that causes persistently high pressure in the middle ear Causes hearing loss, facial pain and paralysis, tinnitus, vertigo, and destroys ear structures
27
What is Meniere disease? S/S? Treatment? Why is a low sodium diet effective?
Abnormal inner ear fluid balance in vestibular system S/S Fluctuating, progressive hearing loss A long-term chronic condition Tinnitus Feeling of pressure or fullness Episodic, incapacitating vertigo that may be accompanied by N/V Low-sodium diet, 1000-1500 mg a day Meclizine, tranquilizers, antiemetics, and diuretics can be used Surgical management Pressure point treatment Inserting a tympanostomy tube, which applies micropulses at intervals to relieve vertigo by displacing fluid of the inner ear Sodium and fluid retention disrupts the balance of fluid in the inner ear
28
What is tinnitis? Vertigo? Ototoxicity? Meds that can cause it?
Ringing in the ear Roaring, buzzing, hissing sound in one or both ears The illusion of motion or a spinning sensation when not occurring Usually occurs from disease in the vestibular ear system r/t medications: gentamycin, erythromycin, furosemide, ethacrynic acid, NSAIDs, chemotherapy agents (cisplatin) 
29
What is benign paroxysmal positional vertigo? Treatment?
Caused by debris (small crystals of calcium carbonate) located within the semicircular canal Sudden onset, can last a few weeks or years Aggravated by any head movements until crystal is out of semicircular canal Treatment: bedrest, meclizine, Epley maneuver to move crystal
30
What is labyrinthitis? Treatment?
Labyrinthitis Often secondary to a viral infection in vestibular system Sudden onset of severe vertigo, NV, hearing loss, and tinnitus Treatment: bedrest, darkened room, meclizine or dimenhydrinate, antibiotics if bacterial
31
What is otosclerosis? Treatment?
Otosclerosis Bones in the middle ear fuse together Leads to conductive hearing loss Treatment: stapedectomy (the stapes is removed and replaced with a prosthesis)
32
What is the indications of meclizine? MOA? What other meds can help aid in treating vertigo?
Treats vertigo from inner ear problems (reduces symptoms to vomit center in brainstem) Antihistamine and anticholinergic effects Adverse effects: sedation, dry mouth, urinary retention, constipation, blurry vision diphenhydramines ondanteron (for nausea) benzodiazapines
33
What is the indication of scopolamine? MOA? Route? AE?
treats nausea associated with inner ear problems Anticholinergic Transdermal  Adverse effects: sedation, dry mouth, urinary retention
34
How does Cushing's present? What is the hormone insufficiency involved? What med presents similarly? Why is there a high glucose level? Why weight gain and toom much fluid?
weight gain buffalo hump moon face hyperglycemia changes inn personality increased infection risk osteoporosis, susceptible to fractures fluid retention striae too much cortisol and aldosterone corticosteroids cortisol is a stress hormone that tells the lover to release more glucose too much aldosterone tells the kidneys to resorb sodium and water follows.
35
What are the stages of HIV? What determines progression to AIDS?
Stage 0: primary infection, feels like a cold Stage 1: HIV asymptomatic (can be for years) Stage 2: symptomatic (CD4 has declined enough that it is susceptible to infections and viral load increases) Stage 3 AIDS CD4 goes below 200 or an opportunistic infection
36
What are DKA interventions? Monitor? What causes the excess ketones? It causes what imbalance?
labs: ABGs and ketone level in urine fluid replacement (NS then D5 when BS 250 IV regular insulin ICU setting potassium (goes into the cells with the insulin so you must watch the shifts in levels) ABGs, renal function, potassium, output, ECG, VS rapid fat breakdown that the body cannot use metabolic acidosis
37
What are the benefits of hormone replacement? Risks?
manages menopausal symptoms such as hot flashes reduced risk of fractures/osteo prevent vaginal atrophy and dryness breast, endometrial and ovarian cancers DVT CAD MI
38
What does a pheochromocytoma affect? What hormones does this affect? What reaction does this increas cause? Manifestations?
adrenal medulla catecholamines--epi and norepi fight or flight response HTN sweating anxiety hyperglycemia tachycardia
39
What are surgical pre-procedure interventions with a client with hemophilia? What is something that can indicate a bleed?
give them the factor they are missing, 8 or 9 check CBC, platelet, INR, coagulation time, Ptt stool, intracranial
40
What are GI manifestation of AIDS?
chronic diarrhea fungal infections wasting syndrome
41
What is PID? What causes PID? What part of the reproductive tract is affected? Complications?
reproductive tract infection STDs--ghonnerra and clamidia upper infertility ectopic pregnancy abnormal discharge pain fever
42
What is multiple myeloma? What electrolyte imbalance does it cause? Why? Complications? Who are typically affected? Where does pain often present first?
blood cancer involving an overgrowth of plasma cells hypercalcemia bone destruction and releases calcium renal failure anemia bone pain older people back ribs
43
What is the screening test for HIV? Confirmation test? Test to evaluate response to meds?
Elisa Western Blot CD4 and viral load
44
What are nursing interventions for a sickle cell vaso-occlusive crisis?
O2 Fluids IV meds transfusion is Hgb is less than 7
45
What is the pharm management for Cushing's?
taper off steroid meds ketoconazole (blocks enzymes that help produce the steroids) Mitotane (if caused by cancer) diuretic antihypertensive
46
What is overproduced with leukemias? What does is affect? What precautions should be in place with these clients? At what point are these precautions implemented?
WBC--they're also immature and dysfunctional It crowds out production of the rest in the bones--platelets and RBCs pancytopenia anemia thrombocytopenia neutropenic precautions When neutrophil count drops below 1000
47
What platelet value would elicit thrombocytopenic precautions?
platelet less than 50,000
48
What is the nature of gonnorhea? Treatment?
discharge pelvic pain can result in infertility antibiotics
49
What are nursing interventions with Addison's disease? How does their skin present? Why?
daily weights IV fluids, electrolyte balance VS corticosteroid relpacement minercorticorsteroid replacement treat hyperkalemia monitor for hypoglycemia Bronze color The pituitary is producing excess ACTH to try to get the adrenal to produce cortisol and aldosterone. ACTH also acts on melanocytes
50
Who is endometrial cancer most common in? What might alert to there being cancer? Risk factors? Why?
elderly bleeding after menopause pelvic pain nulliparity early menarche late menopause longer period of time for hormonal influence
51
Why is Hodgkin typically easier to treat over non-hodgekins?
predictable spread along the lymphatic system, typically happens in younger so age can help with outcome non-Hodgkin has an unpredictable spread
52
What are manifestations of Addison's? Biggest risk?
bronze, ruddy skin weight loss hypotension hyponatremia hyperkalemia weakness hypoglycemia hypovolemia/dehydration N/V/D abd pain anorexia significant hypovolemia that leads to hypovolemic shock
53
What are brachytherapy precautions (radiation treatment)?
radiation sign leave linens in the room until all pellets are accounted for lead apron dosimeter badge no children or pregnant women visitors only 30 min rotate caregivers 6' proximity client does as much as they can for themselves if an implant dislodged, pick up with tongs and put in a lead box
54
How does a hemolytic blood transfusion reaction manifest?
flank pain fever chills anxiety and feeling of doom tachypnea chest pain hypotension tachycardia
55
Anemia manifestations? What symptom is specific to B12/pernicious anemia?
pallor mucous membranes pale sensitivity to cold fatigue dizziness PICA (iron def) dyspnea paresthesia
56
What manifestations of a retinal detachment does the client experience? After surgery how must the client lay? Why?
bright flashing lights sudden onset of floaters "curtain" suddenly covers the vision of the affected eye prone Because a gas bubble has been inserted and it needs to sit at the back of the eye, gas rises so the back of the eye needs to be on top.
57
What is polycythemia vera? What happens to the H&H? Clinical manifestations? What is the concerning complication?
blood cancer with an overproduction of RBCs ruddy complexion splenomeagly HTN pruritis elevated blood becomes more viscous so they are prone to blood clots/thrombosis
58
If ICP is increasing, what is decreasing? Late sign rising?
LOC Glasgow RR HR HTN
59
What is the rule of 9s? What are some percentages of note?
Used to determine TBSA% that is burned Percentage of total body surface area (TBSA) to identify the extent of injury, calculate medication doses, fluid replacement, and caloric needs front of legs 9% back 9% All the leg 18% each Thoracic region: 9% peritoneum: 9% full front trunk: 18% genitals 1% front and back of arms: 4.5% each total arm: 9% front of head, back of head: 4.5% each total head: 9%
60
What is the Parkland formula for fluid replacement when treating burns?
4 mL x % burn (TBSA) x pt wt in kg = total fluids (mL) for 24-h​r ½  of the total volume is given over the first 8 hours​ from time the burn occurred and the remaining volume over the next 16 hours
61
What are the initial lab findings with burns?
K+ is high Na+ is low Hct is high (d/t fluid loss)
62
What IV med treats shock and HF by dilating blood vessels and increasing perfusion to the kidneys?
dopamine
63
What is a priority hx finding with ischemic stroke? Why?
onset of symptoms TPA has a 4.5hr window to be administered
64
What inflammatory condition can be exasperated by diets high in purine foods (liver, meats, alcohol)
gout
65
What is first-line treatment for RA?
methotrexate (DMARD) NSAIDs steroids
66
What manifestations can occur with Lupus?
fatigue lymph node enlargement Raynaud phenomenon joint swelling nephritis pericarditis rash respiratory infections
67
What reproductive disorder is associated with insulin resistance and elevated testosterone? Treatment?
PCOS metformin spironolactone lose weight and symptoms will improve
68
What is the surgery that relieves urinary obstruction with BPH?
TURP
69
When should males check for testicular cancer? Female for breast cancer?
after the shower with clean hands during the shower with soapy hands
70
How does hypothyroidism present? Treatment? What is to be remebered with this med?
constipation decreased mental status bradycardia cold intolerance Levothyroxine take in the AM monitor levels to avoid hyperthyroidism
71
What are S/S of hyperthyroidism? Treatment?
tachycardia palpitations nervousness unintentional weight loss bulging eyes, blurry vision high BP heat intolerance calories PTU
72
What condition presents with head injury, increased thirst and urination?
DI
73
What does the client experience with a thyroid storm?
extreme symptoms of hyperthyroidism fever HTN adb. pain tachycardia
74
What is sclerosis of the ossicles? What does it cause? Treament
otosclerosis--overgrowth of tissue of the bones in the middle ear tinnitus and conductive hearing loss stapedectomy: surgical removal of a portion of the stapes and replacing it with a prosthesis
75

COTAC 2 (6 decks)

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