NURS322 Final Flashcards
3 Causing Factors for Dz in eye
injury
disease
aging
3 Eye Dz’s
Macular Degeneration
Cataracts
Glaucoma
Macular Degeneration
AKA?
Cure?
#1 Cause of…?
Age-related MD
NO CURE
Vision Loss > 60y/o
2 Types Macular Degeneration and Fx
Dry - most common, ■ retinal/capillary arteries r/in ischemic/necrotic macula
Wet - new growth of blood vessels w/ thin walls that leak. OCCURS @ any age
Macular Degeneration Nutritional Risk Factors (2)
↓ Carotene and Vitamin A
MD 3 S/S
↓ Depth perception, distorted, and blurred vision
Interventions for MD?
NONE
Snellen Test HowTo and
Interpretation
Pt stand 20 feet and cover 1 eye
example: 20/50 what pt can see @ 20, a healthy eye can @ 50 ft.
↑ second number, worse vision
MD 2 Diagnostic Tests
Opthalmoscopy and Visual Acuity (Snellen/Rosenbaum)
MD Education (4)
Eat antioxidants, carotene, VitA, B12
Get exams yearly
↓ ADL’s as dz progresses
Get assist services
Foods with… (3 ea)
Carotene
VitA (shares w/ Carotene)
B12
Carrots, sweet potato, dark leafies
Shellfish, liver, fish
Cataracts
▲ in…? and Fx?
3 Key S/S
Opacity of lens of eye r/in impaired vision
Diplopia - double vision
Photosensitivity
Ø red reflex
3 Types of Cataracts
Subscapular - back to front
Nuclear - center out
Cortical - outside (cortex) in
Key Risk Factors Cataracts (4)
UV exposure
Chronic Steroid Use
DM
Trauma
How to Diagnose Cataracts (2)
Looking at it &
Opthalmascope
Surgical removal of Cataracts contraindicated in…? (2)
Infection and bleeding
Cataract pts should report… (4)
Infection (yellow/green drainage)
Hemorrhage
Pain w/ nausea/vomiting
Sudden swelling, light, shapes
Time until vision returns post-cataract op
4 - 6 weeks
What to avoid post-eye op w/ 3 examples
IOP increasing actions (straining, tilting head back in shower, sex)
What is Glaucoma?
Education focuses on…?
S/S (2) Fx…?
IOP Reference Range
Disturbance of optic nerve (Leading cause of blindness)
Education on early detection >40 y/o
↓ drainage ↑ secretion fx IOP
10 - 21 mm/Hg
2 Types of Glaucoma and Fx’s
+Key S/S (3 ea)
Open-angle - most common, angle b2in iris/sclera opens
↓ aqueous outflow which ↑ IOP
↓ Periphery and accommodation (IOP > 21)
Angle-Closure/Closed-Angle - Suuden ↑ IOP b/c same angle closes
SUDDEN ↑ IOP w/ Halos and PAIN
Risk Factors (3) Glaucoma
Age, infx, tumors
Diagnostics (3) Glaucoma
Visual Acuity
Tonometry - IOP
Gonioscopy - drainage
Eye Drops How to (5)
q12h if > 1 drop at a time, wait 10 - 15 min b2in drops Pull down bottom lid, drop Push on punctum Lay for 10 minutes
Glaucoma Surgery
Check IOP?
Contraindication?
Check IOP 1 - 2 hours pre-op
Contraindicated in blindness
Glaucoma med:
Pilocarpine
Route, Type, and Fx (2)
DROP
Miotic
Constricts pupil and ↑ circulation
Glaucoma med:
Diamox
Route (2), Type, and Fx
DROP
Betablocker/Carbonic Anhydrase Inhibtor
↓ IOP by ↓ aqueous humor
PO
Acetazolamide
Pre-OP ↓ IOP pDilating pupils/eye paralysis to stop movement
Glaucoma med:
Mannitol
Route, Type, and Fx
IV
Osmotic Diuretic
in ER to quickly ↓ IOP
Glaucoma med:
Predisolone Acetate
Route, Type, and Fx
DROP
Ocular Steroid
↓ inflammation
What to check if giving Acetazolamides?
Acetazolmaids are sulfa-based meds.
ASK ABOUT SULFA ALLERGIES BEFORE USING.
Middle Ear ▲ are b/c (3) and are caused by (3)
thickening TM
↓ sensory hairs in Organ of Corti
↓ ossicular bone movement
Injury, Dz, Aging
Otitis Media, fx, how to tx (2)
Middle Ear Infx
Inflammation of ossicles
Antibiotics or surgery
Middle Ear 3 Key R/F
Reccurent colds, enlarged adenoids, ▲ air pressure
Otitis Media 3 S/S
▲ TM
Feeling full
Pain in ear
3 Inner Ear Dzs and Fx
Tinnitus - ringing, whirling, dizziness
Labyrinthitis - infx labyrinth (2ndary Otitis Media)
Meniere’s - Tinnitus, Unilateral Sensorineural Hearing Loss, and Vertigo
Inner Ear 2 R/F
Viral/Bacterial Infx
Ototoxic Medications
Inner Ear Dz 4 Key S/S
Tinnitus
Nausea/Vomitting
Nystagmus - involuntary eye movement (regular when looking far though!)
Poor Balance
Ear Diagnostic Procedures (4)
Tympanogram
Otoscopy
Electronystagomography (ENG)
Caloric Testing
Tympanogram measures…?
TM/middle ear structure mobility w/ sound
Otoscopy is used to examine (3)
Procedure for adults vs. children.
Light reflexes R vs L
external canal, TM, and malleus (through TM)
Adults: Up Back
Children: Down Back
Right 5:00, Left 7:00 (towards front basically)
ENG 3 steps
2 pre-op notes (4 no no’s and key device?)
Electrode eyes, stimulate ear with air/water
Ask simple questions
Keep bedrest/NPO until Ø vertigo
FAST pre-op.
No caffeine, alcohol, sedatives, or antihistamines
Ø for pts with pacemaker
Caloric Testing
Diff. temp H2O in pt ear, watch eyes.
Ear care.
Monitor…?
Evaluate…?
Encourage…?
Balance
Home situation
Rising slowly w/ assistive devices
4 Ototoxic medications > 5 days
Antibiotics
Diuretics
NSAIDs
Chemtherapeutic Agents
How to reduce vertigo. Amigo! (5)
↓ stimulation ↓ caffeine/alcohol ↓ Na intake ↑ assistive devices Monitor fluid intake
Eye: Floating spots are a key S/S of…?
Retinal Detachment
Smoking Fx on vertigo?
Ø
Middle Ear Dz on Light Reflex
They’re gone
Ear Med:
Meclizine
Type, Tx for…? Contraindication? Warning?
Antihistamine
Vertigo/inner ear problems
Ø open-angle glaucoma
It sedates
Ear Med:
Droperidol (Inapsine)
Type. Tx for…? 3 Warnings?
Antiemetic
Nausea/Vomiting
HypoTN, tachycardia, ▲ position quickly
Ear Med:
Scopolamine (Transderm Scop)
Type, Tx for…? 3 Warnings?
Anticholinergic
Nausea/Vomiting r/t inner ear dz
URT, sedation, ↑ IOP (care w/ open-angle)
Diuretics fx on Ear
↓ semicircular fluids
Ear Surgical Procedures (3)
Stapedectomy
Choclear Implant
Labyrinthectomy
What is a Stapedectomy?
Target pts, asses for? How is hearing post-op?
remove/replace stapes
Pts with otosclerosis (fused bones) middle ear
Facial nerve dmg
Initially worse
What is a cochlear implant?
Implanted microphone behind ear that converts sound into impulses to auditory nerve
What is a Labyrinthectomy?
Post-Op fx? Expected finding?
Removal of labyrinth
SEVERE nausea/vertigo post-op
Hearing loss is EXPECTED in affected ear
4 MusculoSkeletal Diagnostic Procedures
Arthroscopy
Nuclear Scans (bone, gallium, thallium)
Dual X-Ray Absorptiometry Scans (DX)
Electromyography (EMG)
What is an arthroscopy?
2 Contraindications?
3 Post-Op notes
Physical incision around joint for visualization
Ø with inflammation or pt can’t bend joint 40 degrees
Provide ice
Monitor site
Notify ▲ swelling, pain, infx
SWELLING IS NOT EXPECTED
What is an Electromyography (EMG)? EMG vs. Nerve conduction study? Detects 3 Dzs? Ø if pt is taking (2)? 3 Expectations?
Needling/shocking to detect muscle weakness
Nerve conduction done with pads
Neuromuscular, motor neuron, and peripheral nerve dz
Pt taking anticoagulants/muscle relaxants
Discomfort, flex while needle inserted (ease), bruising @ sites
BONE scans?
Injection time.
Detects…? (3)
GALLIUM/THALLIUM scan r/t BONE SCAN.
Injection Time.
Detects+…? (3)
How long does scan take? May require?
Entire skeletal system
2 - 3 hrs
Fractures, tumors, Bone dz
↑ sensitivity
4 - 6 hrs
Brain, liver, breast dz
30 - 60 minutes, may require sedation.
Assess before Bone scans?
Radioisotope Allergies
Bone scan post-op encourage?
Drinking fluids to excrete radioisotopes
What is Dual X-Ray Absorptiometry (DXA)
WHY DO I LOVE IT?! (3)
Pre-Assess for and remove…?
Estimates density of bone map (hip/spine) and presence of osteoporosis
Non-invasive, Ø contrast, Ø sedation
Metallic objects
Osteoclasts vs. Osteoblasts
Resorption vs. Formation
Bone density age peak range
▲ r/t postmenopause?
18 - 30 y/o
↑ LOSS b/c Ø estrogen
Prevention
2 Foods to eat
Calcium - milk, beans
Vitamin D - fish, egg yolks
Ø carbonated beverages
Sun 5 - 30 min/week
↑ Weight lifting
S/S Osteoporosis (5)
↓ height, ROM
↑ pain, hx fractures
Kyphosis
Bone Labs (5)
First 4 rule out…? (2)
Last 2 rule out…? (1)
Ca, VitD, P
Alkaline P - Rule out Paget’s/Osteomalacia
T3/T4
Serum proteins - Rule out Hyperthyroidism
7 Bone meds and Fx
Thyroid (calcitonine) ↓ bone resorption Teriparatide (Forte) - ↑ bone formation Estrogen Estrogen Agonists - ↓ osteoclast activity Ca - ↑ strong bones VitD - ↑ bone reformation BiPhosphates - ↓#osteoclasts
2 Bone Surgical Interventions
Arthroplasty - joint repair
Kyphoplasty - Vertebroplasty
Most Hip fractures are b/c?
OSTEOPOROSIS DAMMIT!!!
Timing of Physical Therapy for Osteopts?
q20-30m
> 3 glasses of wine a day and ↑↓ BMI r/in?
BONE LOSS
Bedfast pt Bone Education (4)
About... Skin breakdown Posture/Mechanics How to Log roll Heat/Back rubs for relaxation
Paget’s Dz
Osteomalacia
abnormal bone destruction
soft bones
Open vs. Closed Fractures
Break skin surface vs. Ø break skin surface
Open grades…
1 - minimal skin dmg
2 - skin/muscle contusions
3 - dmg to skin, muscle, nerves, blood vessles
Fracture types Complete Simple Comminuted Displaced Non-Discplaced Fatigue Compression
split in 2! 1 line multiple pieces fragments Ø aligned fragments aligned r/t athletics r/t loading for on bone (common osteoporosis)
Fracture types Oblique Spiral Impacted Greenstick
Ø90 degree angle
twisting motion (physical abuse)
1 bone wedged into other
1 side Ø extend through whole bone (children)
5 Types of Immobilization Devices
Casts Traction Splints Internal External Fixation
Casts
3 lengths
3 types
2 material weight/dry time
short, long, leg
walking, spica (congenital hip dysplasia in kids), body (encircle strunk)
Plaster of Paris - heavy 24-72 hr dry
Synthetic Fiberglass - light 30min dry
Moleskin
Used where casts rub against client skin
Cast Assess what? and time intervals? Ice time interval? Handle with...? (body part) Air quality (2) Wear what until completely dry? What to do if damage?
Neurologic checks Qhr (1st 24hr) then q4hr q24-48hrs palms warm dry air Gloves Record outline, date, and time of damage
Things to report r/t casts (5)
painful hotspots S/S infx SOB Breakdown Constipation
Traction
2 Classifications
2 Types
Ensure what are in place? time interval?
Straight/running - line
Balanced - slings w/ ropes
Manual - pulling w/ hands
Skin - w/ weights (Bucks/Bryants)
Weights, q8-12hrs
Traction
Notify provider if…?
pain unrelieved by meds/repositioning
Pin care time interval
2 types of meds given
1 - 2 times a day
Antibiotics and Opiods
What to assess for w/ pins (3)
infx
loosening of pins
tenting @ pinsite
Immobilizers are?
Key trait?
Splints and slings (Ø casts!)
Removable in case of swelling
Open Reduction (Internal Fixation)
Installation of pins inside body which can be removed later
6 Fracture Complications
Compartment Syndrome (ACS) Fat Embolisms DVT Osteomyelitis Avascular Necrosis Failure to Heal
Compartment Syndrome (ACS)
5Ps
2 Txs
Swelling in cast r/in ischemia/edema cycle (w/in 4 - 6 hrs) b/c ↓ circulation
Pain, paralysis, parethesia, pallor, pulelessness
Uni/Bivalve cuts
Fasciotomy - cutting skin for pressure relief
Fat Embolism
3 key S/S
> 70 - 80 y/o injury,
fat travels from bone to lungs
Dyspnea, ↓ LoC, cutaneous petechiae (pinpoint hemorrhages late sign)
DVT 3 Tx’s
Early ambulation
SCD stockings
Anti-coagulants
Osteomylitis
3 S/S and diff. if chronic.
2 Diagnostic tools
4Txs
infx of bone r/in inflammation
pain, fever, ↑WBCS
S/S disappear if infx is CHRONIC
Bone scans, cultures
3 mo Antibiotics
Surgical debridement/antibiotic implantment
Hyperbaric O2
Amputation
Avascular Necrosis
What is it common w/?
circulatory compromise b/c fracture
common w/ hip fractures
Failure to Heal 2 Types (+2 fixes for last one)
Ø healed in 6 monthers
Malunion - improper healng
Nonunion - just not healing
Electrical stimulation and bone grafting
parasthesia
numbness/thingling
Angina
pain b/c ↓ blood flow to ♥
Myocardial Infarction.
Death ETA?
Ischemia/Necrosis of ♥ muscles b/c artery occlusion
Death ETA w/in 1 hr.
♥ Failure (HF) and 3 R/F
inefficient ♥ pumping b/c…
↓ output
hypertrophy
systemic congestion
Valvular ♥ Dz’s
Abnormality in 1/4 or multiple ♥ valves
4 Types of ♥ inflammatory responses
Pericarditis
Mycarditis
Rheumatic Endocarditis
Infective Endocarditis
HOW TO PREVENT ALL ♥ PROBLEMS?! (4)
Stay active
Maintain ↓ cholesterol/BP
Eat ↓ Na/Saturated Fats
Stop smoking.
Angina Pectoris
3 sensations
(aka chest pain) 1st s/s angina
squeezing, heavy pressure, constriction
3 Types of Angina and traits
Stable (exertional) - w/ stress (tx nitroglycerin if pain > 15 minutes)
Unstable (preinfarction) - like above, but frequency and level ↑ over time
Variant Angina (Prinzmetals) - r/t coronary artery spasms when resting
Risk Factors for Angina/MI (7)
post-menopausal ♀ HTN Tobacco use ↑Lipidemia \+Meth/Cocaine Stresssed Old
2 Key S/S Angina/MI
Anxiety of impending doom
Crushing jaw to R arm pain
Angina/MI labs and time window before gone
Myoglobin
4 Angina/MI Diagnostics and what to ask before starting
ECG - evaluate PQRST
Stress Test - evaluate tolerance to activity
Thallium - assess ischemia/necrosis (cold spots)
Catheterization (coronary angiogram)
Iodine/Shellfish allergy (in contrast media)
is ♥ ischemia reversible?
NOPE
♥ Issue Monitoring Solve all (6)
q15min until stable.... then qHr ECG monitoring Urine output hourly O2 ( 2 - 4 L/min) IV access Energy Conservation
♥ Meds (3) and Fx
Nitroglycerin (Vasodilator) - ↓ preload/afterload, 2 doses/5 minutes
Morphine (Analgesic) - pain r/in constipation
Metoprolol (B■) - ↓ HTN, ↑ Survival Rate.
Causes bradycardia/HypoHTN so Øgive if pulse
♥ Blood Thinners (4)
Streptovase/Activase (Thrombolytic Agents) - clot break
Aspirin (Antiplatelet Agent) - watch for bleeding and PUD, Tinnitus = toxicity!!!
Heparin (Anticoagulant) - ↓ clot growth/formation
Glycoprotein IIb/IIa’s
3 Platelet Labs to monitor when giving thinners and normal ranges
PT 11 - 14
PTT 25 - 35 seconds
INR 0.8 - 1.2
↑ time = bad!
Angina/MI Surgical Options (2)
Percuanteous Transluminal Coronary Angioplasty (PTCA) Bypass Graft (CABG)
Angina/MI complications that simply require O2 admin and provider notification
Acute MI - when Ø fixed by Nitro w/in 15 minutes
Ischemic Mitral Regugitation - development of murmur
Ventricular Aneurysm/Rupture - sudden chest pain and HypoHTN
HF/Cardiogenic Shock and proper reactions (3)
Serious pump failure (40% blockage)
Intubation
Ventilation
Med. Administration
Dysrhythmias, med to give in reaction and what to prepare
Anti-dysrhymthmics and a Pacemaker
4 Classes of HF
1 - no S/S with activity
2 - S/S ordinary exertion
3 - S/S minimal exertion
4 - SITTING? DIE!!!
3 S/S Low-Output Failure (L or R?)
L ventricle pump inefficiency, this r/in…
Systolic HF -
R-sided HF key S/S
peripheral edema
LHF Risk factors (4)
HTN
CAD
MI
Angina
RHF Risk Factors (2)
COPD
Pulmonary Fibrosis
HOutput-Failure Risk Factor
↑ metabolic needs
↑ fever
↑thyroidism
Cardiomyopathy Risk Factors (4)
Infection, Cancer Tx, Alcohol, FHx
S/S LHF (3)
Dyspnea
Fatigue
S3 Gallop
S/S RHF (3)
JVP, edema, weight gain
4 Types Cardiomyopathy
Dilated (most common)
Hypertrophic
Arrhythmogenic R Ventricle
Restrictive
Key S/S Cardiomyopathy
Cardiomegaly (↑♥ size)
What 2 conditions mask presence of ♥ failure in older pts?
Lung Dz and Kidney Failure
HF Labs/Diagnostics and importance (6)
Human B-type HBNP ↓ 100 pg/mL = good 100 -300 = present HF > 300 = mild > 600 = moderate > 900 = severe Hemodynamic Monitoring - HF r/in ↑ acronyms (CVP, PAWP, PAP, CO) but ↓ SvO2 (venous o2 sat.) Ultrasound - Normal L pump 55 - 70% Normal R pump = 45 - 60% Transesophageal Echocardiography (TEE) - transduser in esophagus views ♥ Chest X-Rays ECGs
8 HF Meds (2 important fxs)
Diuretics ACE inhibitors Anticoagulants Vasodilators B■ Inotropics - ↑ caridac output (digoxin) Human B-peptides - ↑ Na loss/vasodialtion
What does a Ventricular Assist Device (VAD) do?
pumps ♥ for pt
Why is Pulmonary Edema dangerous
accumulation of fluid in alveoli/lungs r/in HF
2 Types Pulmonary Edema (PE) and causes
Noncardiac - b/c opiate OD, inhaled irritants, rapid IV
Neurogenic - b/c head injury
What to treat Acute Edema with?
HF meds (8 of them) Diuretics ACE inhibitors Anticoagulants Vasodilators B■ Inotropics - ↑ caridac output (digoxin) Human B-peptides - ↑ Na loss/vasodialtion
Pericardial Tamponade and 2 S/S
Counter Tx? and prep for…?
fluid accumulation in pericardial sac
HypoTN and JVP
Administer fluids to aocunter HypoHTN
Prep for Pericardiocentesis
Valve stenosis vs insufficiency
valve narrowing / improper closure
Ventricular Heart Dz (VHF) 3 types
Symptomatic when?
Degenerative - mechanical stress
Rheumatic - gradual calcification/fibrotic ▲
Infective - Infx (commonly strep)
Asymptomatic until late in Dz!
TricuspidS vs TricuspidI
D murmur w/ atrial dysrhythmia
S murmur w/ tachcardia/flutters
PulmonaryS vs PulmonaryI
S murmur w/ angina/cyanosis
D murmur w/ split S2
MitralS vs MitralI
D murmur w/ edema s/s
S murmur w/ edema s/s
AorticS vs AorticI
S murmur w/ narrowed pulse
S murmur w/ widened pulse
Valvular Dz 5 Surgical Interventions
Percutaneous Baloon Valvuloplasty - fuse balloon with commisures Repair Reconstructure Comissurotomy Annuloplasty Ring Insertion
How long does a Prosthetic Valve last?
10 - 15 years
R/F ♥ Inflammation (6)
Strep Infx IV drug use Valve replacement Overcrowding Being Poor
What is Pericarditis and key S/S (2)
inflammation pericaridum common w/ MI/Respiratory infx,
S/S HF when leaning forward, Ø murmur
What is Myocarditis and key S/S (2)
inflammation myocardium
S/S HF w/ murmur
Rheumatic Endocarditis and key S/S (4)
infx endocardium w/ strep r/t URinfx.
S/S lesions, spasms, SOB, rash
What is Infective Endocarditis and key (2) S/S
infx endocardium w/ staph r/t druggies
S/S fever/flus with spliner hemorrhages on nails
Inflammation Labs (3)
Culture - Ø administer med until post-culture!!!
↑ WBC
↑ ESR/CRP
Inflammation (2) Diagnostic Tools
ECG
Echocardiograph
NSAID fx on platelets?
lowers em’
Valve r/t weight gain?
L valves
Phantom pain meds (4)
and pain reduction action pts can do
B■ (propranolol) - dull/burning
Antieleptics (gabapentin/carbamezepin) - sharp!
Antispasmotics
Antidepressants
Press limb toward bed pillow
Inisional pain med?
Analgesics
Amputee prone position time?
What about legs?
q3-4hrs for 20 - 30 minutes unless otherwise
Contract glutes baby!
Stages HTN (5)
Normal 180 / >110
♥ Assessment Anatomical Landmarks (6)
Aortic area- 2nd ICS, R-sternal border
Pulmonic area- 2nd ICS, L-sternal border
Erb’s point- 3rd ICS, L-sternal border
Tricuspid area- 5th ICS, L-sternal border
Mitral area (apex)- 5th ICS, L-midclavicular line
PMI at 5th ICS L-midclavicular line
Buergers Dz (what, s/s, tx) Raynauds Dz (what, s/s, tx)
Occlusive small arteries/veins
First S/S claudification
vasodilation
Vasospasms aterioles UE and LE
S/S pallor/cyanosis
Normal values: CK - MB Troponin I Troponin T Myoglobin
0%
Normal values:
BUN
Creatinine
Blood Glucose
10 - 20
0.5 - 1.5
70 - 120
Normal Values: Na K CA Mg P Cl
135 - 145 3.5 - 5 9 - 10.5 1.3 - 21. 3.0 - 4.5 98 - 106
Normal Values: Urine Specific Gravity UNa UK UCl UOsmo
1.00 - 1.03 75 - 200 26 - 123 110 - 250 200 - 800
Normal Values: T3 T4 HDL LDL ADH
70 - 205
4 - 12
> 50
Normal Values: WBC RBC Hgb Hct
4k - 10k
4.6 - 5.5
13.5 - 15.5
39 - 49
Normal Values: Platelets PT PTT INR
140 - 400
11 - 14
23 - 35
0.8 - 1.2