Neuro, Sensory Flashcards
1
Q
what does the external ear consists of? role?
A
auricle(pinna)
external auditory canal
tympanic membrane(ear drum)
The role is to collect and transmit sound waves to tympanic membrane
2
Q
what does the middle ear consists of?
A
ossicles (malleus, incus, stapes)- 3 small bones that are connected and transmit the sound waves to the inner ear
eustachian tube: a tube that links the middle ear with the back of the nose. Helps to equalize the pressure in the middle ear. equal pressure is needed for the proper transfer of sound waves.
mastoid/ temporal bone
airspace in temporal bone
3
Q
what does the inner ear consists of? role?
A
cochlea: contains the nerves for hearing
vestibule: contains receptors for balance
semicircular canals: contain receptors for balance
4
Q
how can hearing loss affect a pt?
A
ineffective communication
decreased interaction
withdrawal
suspicion
loss of self esteem and security
5
Q
what parts of the ear is affected by conductive hearing loss?
A
outer
middle
6
Q
what causes conductive hearing loss?
A
sound waves are blocked to the inner ear fibers
7
Q
what are the s/s of conductive hearing loss?
A
pt hears better in noisy places
8
Q
how do you treat conductive hearing loss?
A
fix the direct problem
hearing aid
9
Q
is conductive hearing loss preventable? how?
A
yes, monitor and evaluate for problems and treat
10
Q
is conductive hearing loss permanent?
A
majority of the time, no.
11
Q
what parts of the ear is affected by sensorineural hearing loss?
A
inner ear damage
12
Q
what causes sensorineural hearing loss?
A
damage to the inner ear structures, damage to CN 8 or the brain, prolonged exposure to loud noises, meds, trauma, metabolic circulatory problems, infections surgery, meniener’s, dm, myxedema, aging
13
Q
how do you treat sensorineural hearing loss?
A
depends on the problem
meds
surgery
14
Q
is sensorineural hearing loss permanent?
A
yes, there is NO cure
15
Q
is sensorineural hearing loss preventable? how?
A
ototoxicity, listening to loud music
ototoxicity is preventable if caught early and med is discontinued immediately
avoiding listening to loud music
16
Q
what are the s/s of sensorineural hearing loss?
A
hearing deficit and balance problems
17
Q
what meds can cause ototoxicity
A
aspirin
cisplatin
furosemide
gentamycin
quinine
vancomycin
18
Q
what parts of the ear is affected by mixed hearing loss
A
outer
middle
inner
19
Q
what causes mixed hearing loss
A
a mix of causes associated with both conductive and sensorineural damage
20
Q
what are the main function of cranial nerve 8
A
hearing and balance
21
Q
what is tinnitus? how does it affect a pt?
A
ringing of the ears
grief and depression
22
Q
what is vertigo? how does vertigo affect a pt?
A
room spinning while still because of the fluid in the ears or compression of CN 8
HIGH FALL RISK
23
Q
what is the weber’s test
A
detects unilateral hearing loss
24
Q
what is the rinne’s test
A
compares air conduction with bone conduction
25
what is Meniere's disease
dilation of endolymphatic system by over production or decreased reabsorption of endolymphatic fluid
26
what causes meniere's disease
any factor that increases endolymphatic secretion in the labyrinth, viral and bacterial infections, allergic biochemical and vascular disturbance, changes in the microcirculation in the labyrinth, long term stress
27
what are the s/s for menieres disease
fullness in the ear, tinnitus, vertigo, n/v, nystagmus, severe headache
28
what interventions should the nurse focus on for a pt with Meniere's disease
safety measures
environmental control
surgery
post op interventions
29
how is Meniere's disease treated
med/ symptom mangement
surgery
stunt
resection of CN 8 or total resection of labyrinth
30
nursing care of hearing loss? what are the 8 important key factors for caring for a pt with a hearing deficit?
assessment
safety measures
dietary
meds
surgery
hearing aides
community resources
communication techniques
31
what is the process of administering eye drops
apply to conjunctive sac, light amount of pressure to the canthus to avoid systemic effect
32
what are the 4 leading causes of blindness
age-related macular degeneration
cataracts
diabetic retinopathy
glaucoma
33
what is aqueous humor? what is it made of? where is it made? what is the function?
99.9& water 0.1% sugar, vitamins, proteins
helps maintain intraocular pressure, transports vitamin c to and from the segment and acts as an antioxidant
34
what is the normal flow of aqueous humor
posterior chamber to the anterior chamber to trabecular meshwork to canal of schlemm
35
what is vitreous humor? what is it made of? what is the function?
99% water 1% collagen
to keep the shape of the eye
36
cranial nerve that affect the eyes
2 optic
3 oculomotor
4 trochlear
6 abducens
7 facial
37
what are cataracts
opacification of the lens
38
what are s/s of cataracts
opaque lens
blurred vision
foggy or fuzzy
decreased visual acuity
no pain
occurs gradually
decreased night vision
39
treatment for cataracts
surgery
40
what is glaucoma? where is the initial visual loss going to occur
disturbance of the functional/ structural integrity of the optic nerve
increase of intraocular pressure
41
what is closed angle glaucoma? s/s? treatment?
increased IOP that rise is sudden
fluid builds up in the posterior chamber and directly affects the optic nerve
can cause irreversible damage
EMERGENCY
42
what is open angle glaucoma? s/s? treatment?
outflow is decreased
fluid build up in anterior portion of the eye in front of the lens
43
what are beta adrenergic blocking agents and what are their function
lowers IOP by reducing production of aqueous humor
44
what are timolol contraindications? adverse reactions? pt teaching for home use?
contraindications: asthma, COPD, sinus bradycardia, heart failure
adverse reactions: bronchospasm, dyspnea, bradycardia, dizziness, heart block
45
what is macular degneretion? where is the initial visual loss going to occur? when you are going over paperwork with the pt where will you want to stand to talk to the pt?
degeneration of macula in back of the eye along with forveacentrails
side of the bed
46
s/s for dry macular degeneration? cure? pt teaching?
develops gradually
need for brighter light
gradual haziness of central or overall vision
NO cure
Antioxidants, zinc and selenium
diet, fruits veggies, fish with omega 3
47
s/s for wet macular degneration? cure? pt teaching?
abrupt onset
rapid worsening and vision loss
well-defined blurry/ blind spot of central vision
no cure, only slowing of progression
injections into eye
photodynamic therapy
48
Cataract causes
age related
trauma
smoking
alcohol use
radiation
uv light exposure
certain drugs
diabetes
49
preop treatment for cataracts
mydriatic, cycloplegic agent
NSAID's
topical antibiotics
Antianxiety meds
50
post op cataract treatment
topical antibiotic
topical corticosteroids
eyepatch or shield
mild analgesia
HAND HYGIENE
51
the nurse is developing a teaching plan for a client with glaucoma. Which instruction should the nurse include in the plan of care?
Eye medication will need to be administered for life.
52
What is Cranial nerve #8 responsible for?
Auditory (vestibulocochlear) is responsible for balance and hearing.
53
What clinical manifestations are associated with hearing loss?
Ineffective communication, Decreased interaction, withdrawal, suspicion, loss of self-esteem and insecurity.
54
How do you check if a patient with hearing loss understood what you were communication to them?
Have the patient teach back. Also, have a family/friend at bedside to also get education.
55
What part of the ear is affected if the patient has conductive hearing loss?
outer and middle ear
56
What part of the ear is affected if the patient has sensorineural hearing loss?
inner ear damage
57
What are two of the priority symptoms that we are assessing for with hearing loss that is caused by compression of cranial nerve #8?
tinnitus and vertigo
58
What is tinnitus and what is your priority assessment for the patient suffering with tinnitus?
ringing of the ears can cause suicidal ideation
59
What is Vertigo and what is your priority assessment for the patient suffering with vertigo?
Room is spinning while the patient is still. Patient is a high fall risk.
60
What are the some of the causes of Conductive hearing loss?
Otitis media with effusion, poor eustachian tube function, impacted cerumen, tumors, objects present, middle ear disease, otosclerosis
61
What is Meniere’s disease?
Refers to the dilation of the endolymphatic system by overproduction or decrease reabsorption of endolymphatic fluid. (Basically, too much fluid causing pressure on cranial nerve #8.
61
What are some of the causes of Sensorineural hearing loss?
Illness, genetics, loud noises, ototoxicity, and aging
62
True or false: Sensorineural is permanent hearing loss that cannot be fixed by surgery or medicine?
true
62
What medications cause ototoxicity in sensorineural hearing loss?
1. Vancomycin 2. Gentamycin 3. Cisplatin 4. Aspirin 5. Furosemide 6. Quinine
63
What treatments can be done for a patient with Meniere’s disease?
Mild diuretics, vestibular rehabilitation, surgery.
63
What communication technique is the most effective for a patient with hearing loss?
Talk Low and Slow. Can also use written instructions for patient.
63
How long do you hold pressure on the inner eye after administering eye drops?
at least 15 sec
64
What part of the eye do you administer eye drops?
Nasolacrimal duct/conjunctival sac.
65
What are the four leading causes of blindness?
Age related macular degeneration, Cataract, Diabetic Retinopathy, Glaucoma.
65
Why do you want to apply pressure to the nasolacrimal duct/ conjunctiva after administering eye drops?
To prevent systemic absorption (Decrease of blood pressure and heart rate)
66
What is Cranial nerve #2 responsible for?
Optic nerve is responsible for the visual acuity.
67
What is Cranial nerve # 3 responsible for?
Oculomotor is responsible for opening of eyelids, eye movement upward/medial, upward/lateral, medial, downward/lateral.
68
What is Cranial nerve #6 responsible for?
Abducens nerve is responsible for eye movement lateral
68
What is Cranial nerve #7 responsible for?
Facial nerve is responsible for facial muscle movement (except chewing), and eyelid closing.
68
What is Cataract defined as?
Opacification of the lens.
68
What is Cranial nerve #4 responsible for?
Trochlear nerve is responsible for eye movement downward/medial)
69
What is the number one risk factor for cataracts?
Age is the number one risk factor followed by diabetes mellitus, UV light, 2nd use of corticosteroids, and trauma.
70
What safety education do you want to provide the patient diagnosed with cataracts?
Do not drive at night because of low visibility from light not being able to go through. There will be a glare/Halo around light sources at nighttime.
71
What is the treatment for cataracts?
surgery
71
What part of the vision does glaucoma affect?
Peripheral vision (Glaucoma, Peripheral) Gatorade and Powerade
71
If the patient has any unexpected complications after cataract surgery, what should you do?
Call the surgeon even if it is just pain!
72
What part of the vision does macular degeneration affect?
Central vision (Macular-McDonald’s, Central Chick fila)
72
What is the difference between open and closed glaucoma?
Open is gradual IOP build up. Closed is a rapid buildup 24-48 hour to fix before permanent damage.
73
What is the difference between dry and wet macular degeneration?
Dry is drusen buildup that is gradual. Wet is drusen with hemorrhage and neovascularization that is rapid.
73
Is there a cure for macular degeneration?
No cure just slowing of progression.
74
For a type I diabetic when should they have an eye appointment?
Within 5 years of diagnosis and then yearly.
75
For a type 2 diabetic, when should they have an eye appointment?
Upon diagnosis and then yearly.
75
sbar stands for
situation backgtound assessment recommendation
76
quality improvement is
what can we change to give better care and make sure incidents don't happen again
76
model for improvement
plan do study act
76
status of pt includes
pt hix
vs
meds
physical examination
plan of care
psychosocial issues
77
we can prevent med erros by
cus
i am concerened
i am uncomfortable
this is a safety issue
78
magnet recognition is
delegation that empowers nurses through shared governments to provide the best nursing care and outcomes
78
magnet recognition measures
strength and quality of nursing
empowerment
shared decision-making
accountability
79
picot formal is
pt population
intervention
comparission
outcome
time period
79
team members includes
fatigue
workload
task performance
skill
stress
79
environmental includes
facility info
admin info
hr
triage acuity
equipment
79
progress toward goal includes
status of team pts
establish goals of team
task/ actions of team
plan still appropriate
80
why is evidence based practice matter?
problem solving approach to clinical decision making
using the best available evidence with your expertise and pt preferences to make decisions and improve pt outcomes
81
inclusion criteria
the elements of an article that must be present in order for it to be eligible for inclusion in a literature review
82
exclusion criteria
the elements of an article that disqualify the study from inclusion in a literature review
82
what do speech pathologist do
swallowing assessment and treatment
speech and language evaluation and treatment
cognitive assessment and treatment
83
dysphagia
difficulty swallowing
83
dysphagia is caused by
structural, functional, or cognitive factors
84
structural dysphagia causes
oral ca
poor detention or ill fitting dentures
throat ca
diverticulum
84
functional dysphagia causes
acute neuro event: cva, head injury
progressive neuro disorders: PD, tumors, ms
general weakness: aging, decompensation, cardiac meds
esophageal patho: reflux, motility disorders
85
cognitive dysphagia causes
dementia
head injury
lethargic or obtunded pts
may affect feeding
85
nurses role with dysphagia
assistance with oral care and feeding
85
top 3 risk for aspiration penumonia
dependence on others for feeding
dependence on others for oral care
missing or decaying teeth
86
slient aspiration
food/ water going into airway and they don't feel it
may have a gurgly voice
no cough reflex
86
dysphagia s/s
can not manage oral secretions
difficulty chewing, prolonged chewing
pocketing of food
holding food in mouth
excessive drooling
absent swallow
coughing/ choking after swallowing
wet gurgly voice
pain with swallowing
swallowing many times for small bolus
weight lost
dehydration/ malnutrion
87
feeding/ swallowing precautions
chin tuck
thickened liquids
follow up swallows
straws vs no straws
throat clearing
88
clear liquid diet
broth, jello
can see through it
89
full liquid diet
yogurt
pudding
89
what is the cause of aspiration
oral bacteria
89
alert
awake and responsive, follows comand
89
lethargic
sleepy but arousable, drowsy
90
what is the first indication that central neuro function has declined
change in loc
90
dysarthia
difficulty articulation
90
comatose
not arousable
91
stuporus
arousable with difficulty needs vigorous stimulation
92
ischemic stroke
ischemia to part of brain
93
hemorrhagic
hemorrhage into the brain
94
is it a stroke? act fast
face droops
arm weakness
speech difficulty
time is critical
95
patho of a stroke
sudden deprivation of oxygen and nutrients
96
what diagnostic studies are done to confirm it is a stroke
ct and mri
97
nonmodifiable risk factor for stroke
age
gender
family hx
ethnicity
98
modifiable risk factors for stroke
**HTN
DM
obesity
sleep apnea
BCP
Cardiovascular problems
smoking
99
transient ischemic attack is
a transient episode of neurological dysfunction
100
ischemic stroke is
inaquedate blooocclusiond flow (o2) to the brain due to occulusion
101
types of ischemic strokes
thrombotic
embolic
102
thrombotic stroke
occurs from injury to a bv wall and formation of a blood clot
narrowing the bv, so blood clot block passage
MOST COMMON
associated with DM and HTN
103
embolic stroke
embolus dislodges and circulates in the blood, then reaches a narrow bv and blocks passage
most originate from the heart
leads to mi or edema
Pt is CONSCIOUS
s/s can be temporary, HA
time is crucial
104
hemorrhagic stroke
bleeding into brain
105
causes of a hemorrhagic stroke
htn
anoresym
arterial venous
106
intracerebral stroke
bleeding within the brain caused by a rupture of a bv
occurs during activiy
poor prognosis
106
intercerbral most common cause
htn
107
clinical manifestations for intracerebral stroke
neuro deficits
decreased loc
n/v
ha
108
subarachnoid stroke
intracranial bleeding into the csf filled spaces between the pia matter and arachnoid
109
subarachnoid stroke causes
trauma , drug use, aneurysm
110
motor deficits in strokes
hemiplegia
hemiparesis
ataxia
111
communication problems in stroke
dysarthia
dysphagia
aphagia
112
cognitive impairment in stroke
memory loss
decrease attention span
poor reasoning
altered judgement
113
psychological effects in stroke
loss oc self control
depression
emotional ability
114
how do we confirm a stroke
by a ct or mri
115
a ct scan and mri tell us what about a stroke
the size and loctation
if it is a ischemic or hemorrhagic
116
types of diagnostic studies for strokes
ct mri
cerebral angiography
digital subtraction angiography
transcranial doppler
carotid duplex scanning
caotid imaging, ecg
cbc
csf analysis
coagulation studies ultrasonography
117
interprofessional care for stroke prevention
mangement of modifiable risk factors
healthy promotion
118
drugs that prevent development of thrombus or embolus
antiplatlets
aspirin
oral anticoagulation
statins
warfarin
119
tpa
for ischemic strokes
non contrast ct of head
blood test for coagulation studies
screening of hx of gi bleeding
MUST give withing 3-4 1/2 hrs that s/s begin
120
surgical mangement for ischemic stroke
carotid endarterectomy
carotid stenting
121
surgical mangement for hemorrhagic stroke
aneurys clipping, coiling
resection of arterio malformation
122
acute nursing interventions for stroke
frequent neuro checks
monitor cardiovascular system
monitor musculoskeletal system
monitor for skin breakdown
monitor for constipation
123
