PCC 2 Exam 3 Flashcards
1
Q
What is a Cataract?
A
A cataract is an opacity in the lens of an eye that impairs vision, it is slow and painless blurring of vision. Can be cured through surgery.
2
Q
What are the risk factors for Cataracts?
A
+50 years, diabetes, family hx, smoking/alcohol, obesity, HTN, trauma to eye, sun exposure, corticosteroid, Caucasian
3
Q
What visual changes happens with cataracts?
A
Lens is cloudy/opaque, with gradual loss of vision
Lens clouding: decreased light to retina leading to limited vision
Development is slow and painless
4
Q
Symptoms of Cataract?
A
Main characteristic: Painless and slow onset blurring of vision
Hazziness of lens, inability to see fundus, no red reflex
Halos around objects, loss of acuity from dimness to distortion, reading, and night driving difficulty, decreased color perception
5
Q
Cataract Pre-Op teaching
A
NPO, void prior, measures to decrease IOP, eyedrops to dilate pupil, informed consent, may clip eyelashes
Eyedrops to dilate pupil
6
Q
Cataract Pre-Op Medication
A
Mydriatics
Client education:
1. Report headaches
2. Sensitive to light and to wear sunglasses till the dilation subsides
NSAID
Client education
1. Alert MD if pain increases or pressure build in the eye.
Remind patient the importance of adherence to medication
7
Q
Cataract Pos-op teaching
A
Report drainage (, excessive tearing, or decline in visual acuity, wear eye shield for 2-3 weeks, resume normal self care activities, and no heavy lifting
Bleeding and elevated IOP can indicate infection
Use eye drops to constrict pupil
8
Q
Cataract Post-Op medication
A
Corticosteroids (Prednisolone)
Client Education:
1. Report if presume around eye or edema
Antibiotics
Client Education
1. Report signs of infections
Overall remind patient of importance of medication adherence
9
Q
Cataract Post-Op Complication
A
Infection, wound dehiscence, hemorrhage, severe pain, uncontrolled/elevated IOP
Patients with cognitive impairment should have careful supervision 24 hours after surgery
Call the PCP if:
Pain, conjunctival infection, vision loss, sparks, flashes, floaters, N/V, excessive coughing
10
Q
Activities that increase IOP
A
Bending over at the waist
Sneezing
Blowing nose
Coughing
Straining
Head hyperflexion
Restrictive clothing, such as tight shirt collars
Sexual intercourse
11
Q
What is glaucoma?
A
A disturbance of the functional or structural integrity of the optic nerve.
Irreversible
12
Q
What are the diagnosis used for Glaucoma and the recommended screening schedule?
A
Diagnosis
1. Measure of IOP and visual acuity
Extra: gonioscopy is used to diagnose open or close angle glaucoma
Screening schedule: screening should start annually at 40 years
13
Q
What if glaucoma is left untreated?
A
Needs to be Diagnosed early to prevent loss of vision; can’t reverse damage that has occurred but can control IOP
14
Q
What are the medication for Gluacoma?
A
Beta-blockers (timolol)
Adrenergic (lopidine, alphagan)
Miotic/Cholinesterase Inhibitors (pilocarpine)
Carbonic anhydrase inhibitors
Prostaglandin analogues
15
Q
What are the medications for Cataract?
A
Mydriatics (preop) (HA, photosensitivity)
NSAID (preop) (increase IOP and pain)
Corticosteroids (postop) (pressure in eye and edema)
Antibiotics (postop) (infection)
16
Q
Detached Retina S/S
A
Sx: curtain like shadow over visual field, sudden appearance of floaters, flashes of light in one or both eyes, blurred vision, gradually reduced peripheral vision
17
Q
Adrenergic (lopidine, alphagan)
A
Client education:
Alert MD if experience palpitation, HTN, tremors, sweating
Nursing implications
Monitor VS, neuro function, respiratory status
17
Q
Detached Retina Nursing Care
A
Evaluate functional ability
ADLs (reading, medication labels), transportation, ambulation, preparing food, engaging in recreational activities
If functional ability is not intact, create plan
18
Q
Miotics/Cholinesterase Inhibitors (pilocarpine)
A
Client education
Watch for signs of bronchospasm, salivation, nausea, vomiting, diarrhea, abdominal pain, lacrimation
Nursing implications
Monitor VS, bowel pattern, pain level, tear production
18
Q
Detached Retina Corrective Procedure
A
Gas bubble: helps to push retina back to the wall of the eye so it can reattach
19
Q
Carbonic Anhydrase Inhibitors
A
Client education
Alert MD to signs of fatigue, renal failure, hypokalemia, diarrhea, depression COPD exacerbation
Nursing implications
Monitor VS, Potassium levels, bowel patters, COPD management
19
Q
Macular degeneration Types
A
Dry: atrophy
Wet: exudate
20
Q
Prostaglandin Analogues
A
Client education
Alert MD to signs of changes in eye color, periorbital edema, itching
Nursing implications
Monitor eye color, edema, and report itching
20
Q
Macular Degeneration S/S
A
blurred vision, center of vision is dark, develop central loss of vision, impaired reading and recognition of objects, side vision and mobility are intact
21
Mydriatics
Pre-op Cataract
Client education
Alert MD to increasing headaches.
Remind client they will be sensitive to light and to wear sunglasses till the dilation subsides
Nursing implications
Instruct client on importance of adherence to regimen
21
Macular Degeneration Teaching
Wear UVA and UVB protection
Diet
Fruits and vegetables to increase consumption of antioxidants
Carrots have beta carotene
Supplements
Zinc oxide (80 mgm)
Cupric oxide (2 mg)
Beta carotene (15 mgm)
Vitamin C (500 mgm)
Vitamin E (400 IU)
22
NSAID
Pre-op Cataract
Client Education:
Alert MD if pain increases or pressure builds up in the eye.
Nursing implications:
Instruct client on importance of adherence to regimen.
22
Drugs that have risk for Hearing Loss
How to tell if it is ototoxic: can it effect your kidney? If yes, it can effect ears
Aminoglycoside antibiotics (-mycin)
Antineoplastics (cisplatinum)
Loop Diuretics (furosemide)
Propranolol
ASA/NSAID
23
Corticosteroids (prednisolone)
Post-op Cataract
Client education
Alert MD if pressure around eye or edema
Nursing implications
Instruct on importance of med adherence
23
Hearing Aid Care
Remove and clean at bedtime
No alcohol or harsh soaps
Use damp cotton pad/cloth with either water/saline
Carefully remove cerumen
Disengage battery
Store in safe place
24
COPD Diagnosis
Pulmonary Function Test: FVC, FEV1, FEV1/FVC ratio is less
than 70%
* Sputum cultures & WBC & CBC
* AAT to assess for alpha1 antitrypsin deficiency
* Chest x-ray
* Arterial Blood gases (ABGs)
* * Respiratory acidosis, metabolic alkalosis compensation
* Hypoxemia PaO2 <80mm Hg
* Hypercarbia increased PaCo2 > 45 mm Hg
24
Antibiotics
Post-op Cataract
Client education
Alert MD of sx of infection
Nursing implication
Importance of med adherence
25
Cataract complications
Infection, wound dehiscence, hemorrhage, severe pain, uncontrolled/elevated IOP
Patients with cognitive impairment should have careful supervision for at least 24 hours after surgery
When to call PCP
Pain, conjunctival infection, vision loss, sparks, flashes, floaters, N/V, excessive coughing
25
COPD assessment
Baseline, edema, JVD, elevated VS, and use of accessory muscles
26
Detached Retina S/S
curtain like shadow over visual field, sudden appearance of floaters, flashes of light in one or both eyes, blurred vision, gradually reduced peripheral vision
26
COPD Causes
3 factors: fluid build up, inflammation, and bronchoconstriction
Emphesema does not have fluid (mucus) build up
27
Detached Retina Nursing care
Evaluate functional ability
ADLs (reading, medication labels), transportation, ambulation, preparing food, engaging in recreational activities
If functional ability is not intact, create plan
27
Difference between chronic bronchitis and emphysema
Chronic Bronchitis (Blue Bloaters)
Overweight and cyanotic, elevated hemoglobin, peripheral edema, and rhonchi and wheezing
Emphysema
Older and thin, sever dyspnea, quiet chest, xray flattened diaphragm with hyperventilation
Emphysema does not have mucus build up so they have quiet lung sounds; in contrast, chronic bronchitis will have rhonci and wheezing
28
Detached Retina corrective procedure
Gas bubble: helps to push retina back to the wall of the eye so it can reattach
28
Emphysema (pink puffer) definition
Abnormal or permanent enlargement of the airspace (no mucus)
29
Macular Degeneration Types
dry and wet
Dry: atrophy
Wet: exudate
29
Chronic Bronchitis (Blue Bloaters) Definition
Chronic productive cough for three months
30
Macular Degeneration s/s
blurred vision, center of vision is dark, develop central loss of vision, impaired reading and recognition of objects, side vision and mobility are intact
30
Management of COPD and Asthma Exacerbation
PFT for asthma but cannot be used for COPD exacerbation
Bronchodilators
High fowler's position, cardiac monitoring, sputum culture
Status asthmaticus: Episode that is unresponsive to common treatment. Use medication as prescribed, SA can lead to respiratory and cardiac arrest.
31
Macular Degeneration Client Teaching
wear UVA/UVB protection
Diet and Supplements
31
Emphysema Dyspneic Episode Intervention
Tripod position, administer bronchodilator, diaphragm and purse lip breathing, encourage alternating activity with rest period, and teach techniques of chest physiotherapy
32
Macular Degeneration Diet and Supplement
Diet
Fruits and vegetables to increase consumption of antioxidants
Supplements
Zinc oxide (80 mgm)
Cupric oxide (2 mg)
Beta carotene (15 mgm)
Vitamin C (500 mgm)
Vitamin E (400 IU)
32
Asthma Diagnosis
PFT, X-ray for fluid development, sputum culture, normal FEV1/FVC 70-75%
33
Hearing Loss Risk factor
Long term exposure to excessive noise, impacted cerumen (ear wax), ototoxic medications, tumors, diseases that affect sensorineural hearing, smoking, hx of middle ear infection, chemical exposure
Cerumen impaction: using lavage, cotton swabs, irrigation to remove cerumen and puncturing ear drum
Conductive hearing loss: blocked movement of sound
***Impacted cerumen, otitis externa/media, tumor, foreign body
33
Asthma Management
Prevent Sx that impact QOL, prevent exacerbations, maintain normal activity levels and PFTs, minimize side effects
Decrease risk of exposure, position high fowlers, administer I2 and medication as prescribed, monitor cardiac and respiratory function during exacerbation.
34
Drugs with risk of hearing loss
How to tell if it is ototoxic: can it effect your kidney? If yes, it can effect ears
Aminoglycoside antibiotics (-mycin)
Antineoplastics (cisplatinum)
Loop Diuretics (furosemide)
Propranolol
ASA/NSAID
34
Management of COPD
Prevent disease progression, relieve symptoms, improve exercise tolerance, improve health status, prevent and treat exacerbations, reduce mortality
35
Hearing Aid Care
Remove and clean at bedtime
No alcohol or harsh soaps
Use damp cotton pad/cloth with either water/saline
Carefully remove cerumen
Disengage battery
Store in safe place
35
COPD Exacerbations
Most common cause is infection and air pollution
Usually benefit from use of bronchodilators, oral steroid, and antibiotics
36
Hearing Loss communication
Cochlear implants, assistive listening devices (amplifier, telephone devices)
36
Pulmonary rehabilitation
Improvement of QOL through breathing, relaxation techniques, smoking cessations, energy conservations, exercise, and group support
37
COPD diagnosis
Diagnosis
Cannot perform PFT during exacerbation (FEV1/FVC ratio is < 70%)
37
Oxygen Toxicity
Oxygen toxicity:
1. Early sign: cough, substernal pain pain, nasal stuffiness, and decreased vital capacity
2. Late signs: edema, sputum, and lung fibrosis
COPD goals are to keep hypercapnic (higher CO2) and hypoxic (lower O2)
1. Oxygen can be around 90-92
2. never go above 4L/min
3. 100% only in emergency
38
COPD assessment
Baseline assessment, general appearance, edema/JVD, tachycardia, tachypnea, diaphoresis, accessory muscles, tripod posture, sputum production, hypoxia, breath sounds, labs
Indication of deterioration when patient is hyperventilating
Rapid, shallow respirations
38
COPD Complication and education
Pneumothorax, respiratory failure, cor pulmonale/right sided heart failure, oxygen toxicity
Infection sx, proper hydration, proper use of oxygen, use of medication, immunization, climate considerations
39
What are the three constrictive diseases causes of COPD?
Emphysema (pink puffer)
Chronic Bronchitis (blue bloater)
Asthma
39
Beta 2 - adrenergic agonist
Albuterol: inhaled = short acting
Terbutaline: PO = short acting
Salmeterol, Formoterol: inhaled = long acting
40
What is emphysema and S/S?
Abnormal and permanent enlargement of the airspaces (no mucus)
Sx: older, thin, dyspnea, quiet chest, barrel chest, tripod
40
COPD Long term Control
Inhaled corticosteroids – Fluticasone (Flovent HFA); Rinse mouth after use; use spacer
Leukotriene modifiers – montelukast (singulair)
Theophylline – Theo-24 taken in pill form; relaxes airways and decreases lungs response to irritants;
* SE: insomnia/GERD: blood levels must be checked
Long acting Beta 2 agonists – salmeterol (serevent); used in combination with inhaled corticosteroids
Combination Drugs – Advair Diskus, Symbicort
41
What is dyspneic episode and what to do in a dyspneic episode?
Dyspneic episode
Education: Sit up and lean on a table, sand and lean against wall, sit up with elbows resting on knees
Intervention: administer prescribed bronchodilator first, teach diaphragmatic and pursed lip breathing, encourage alternating activity with rest periods, and teach techniques of chest physiotherapy
41
COPD relievers
Short-Acting Beta Agonists - Albuterol
Complication: Tachycardia and tremors
42
Chronic Bronchitis (blue bloater) s/s
Chronic productive cough for three months
Sx: overweight, cyanotic, elevated hemoglobin, peripheral edema, rhonchi, wheezing, prolonged expiration, clubbing
42
COPD Controllers
Long-Acting Beta Agonists - Salmeterol and formoterol
43
Asthma Causes
Mucosal edema (inflammation), bronchoconstriction, and excessive mucus production
43
COPD preventers
Fluticasone and Beclomethasone
44
Asthma Diagnosis
PFT can be done during an exacerbation
X-ray for fluid development
Sputum to rule out infection or to determine the cause
Normal FEV1/FVC ratio: 70-75%
44
The nurse is teaching a client with emphysema about positions that help breathing during dyspneic episodes. The nurse instructs the client that which positions alleviate dyspnea?
Select all that apply.
1. Sitting up and leaning on a table
2. Standing and leaning against a wall
3. Lying supine with the feet elevated
4. Sitting up with elbows resting on knees
5. Lying on the back in low-Fowler’s position
Answers 1, 2, and 4.
45
Asthma Management
Prevent sx that impact QOL, prevent exacerbations, maintain normal activity levels and PFTs, minimize side effects
Decrease risk of exposure, position pt in high fowlers, administer O2 and medications as prescribed, monitor cardiac rate and rhythm during attack
45
The nurse is caring for a dyspneic client with decreased breath sounds. The nurse should carry out which intervention to decrease the client's work of breathing?
1. Instruct the client to limit fluid intake
2. Place the client in low-Fowler’s position
3. Administer the prescribed bronchodilator
4. Place a continuous pulse oximeter on the client
Answer 3: Administering the prescribed bronchodilator will help to decrease airway resistance, which decreases the work of breathing and should ease the client's dyspnea.
46
Asthma Education
Complications: respiratory failure and status asthmaticus (life threatening episode)
Encourage fluids, take prednisone with food, anti inflammatory to prevent attack, good mouth care, encourage vaccinations
46
The nurse monitors the respiratory status of the client being treated for acute exacerbation of chronic obstructive pulmonary disease (COPD). Which assessment finding would indicate deterioration in ventilation?
1. Cyanosis
2. Hyperinflated chest
3. Rapid, shallow respirations
4. Coarse crackles auscultated bilaterally
Answer: 3 An increase in the rate of respirations and a decrease in the depth of respirations together indicate deterioration in ventilation.
47
Asthma Management objectives
Prevent disease progression, relieve symptoms, improve exercise tolerance, improve health status, prevent and treat exacerbations, reduce mortality
Exacerbations
Most common cause is infection and air pollution
Usually benefit from bronchodilators, oral steroids, and antibiotics
47
Which nursing interventions are appropriate in caring for a client with emphysema?
Select all that apply.
1. Reduce fluid intake to less than 1500 mL/day
2. Teach diaphragmatic and pursed-lip breathing
3. Encourage alternating activity with rest periods
4. Teach the client techniques of chest physiotherapy
5. Keep the client in a supine position as much as possible
Answer: 2, 3, and 4 Fluids are encouraged, not reduced, to liquefy secretions for easier expectoration. Diaphragmatic and pursed-lip breathing assists in opening alveoli and eases dyspnea. The client should be encouraged to perform activities and exercise, such as dressing and walking, as tolerated with rest periods in between. Chest physiotherapy consists of percussion, vibration, and postural drainage. These techniques are helpful in removing secretions. Elevating the head of the bed assists with breathing.
48
Asthma Pulmonary rehabilitation
Improves QOL through breathing, relaxation techniques, smoking cessation, energy conservation, exercise, and group support
48
Normal Neurologic changes in aging.
Everything cognitive decreases except for pain threshold
49
Asthma Oxygen therapy
Oxygen toxicity
Early sx: decreased vital capacity, cough, substernal pain, nasal stuffiness
Late sx: edema, sputum, lung fibrosis
Goal is to keep patient hypercapnic (high CO2) and hypoxic (low O2)
Pulse ox should be 90-92%
Never go above 4L/min
In emergency, give 100% O2 if prescribed
49
Dementia Diagnosis
Two cognate functions must be significantly impaired for dx:
1. Memory,
2. Communication & language,
3. Attention span (or ability to focus and pay attention),
4. Reasoning and judgment,
5. Visual perception.
50
Asthma Client education
Complications: pneumothorax, respiratory failure, cor pulmonale/right sided heart failure, oxygen toxicity
Sx of infection, proper hydration, proper use of oxygen, proper use of medications, immunizations, climate considerations
Nutrition
High fat, low carb (slide 42)
50
Mini-Cog exam
three-item recall and a clock drawing test to determine easily and quickly detect dementia
A positive mini-cog indicate further assessment
51
The Mini-Mental Exam
Determines level of cognitive impairment and not dementia severity. It is usually used for cognitive impairment test
52
FAST Scale
The higher the number, the more assistance they would need (about 4+)
Once they are in 4, they will need help with ADL
53
Difference between Dementia and Depression
If person is responding appropriately to questions, then it indicates depression
If patient is not responding appropriately to question, then it indicate dementia
54
Know Alzheimer’s drug and when they are used in the progression of the disease
Mild-Moderate dementia
Donepezil (aricept)
Rivastagmine (exelon)
Galantamine (Razadyne)
They all have GI complication
Moderate to severe
Memantine (Namenda)
Can be added with other medication
55
What medication is used for mild-moderate Dementia?
Cholinesterase Inhibitors
Donepezil (aricept) - can also be used for moderate to severe dementia
Rivastagmine (exelon)
Galantamine (Razadyne)
56
What to use for Moderate to Severe Dementia?
Memantine (Namenda)
Can be added with other medication
57
Complimentary antioxidants for Dementia
Vitamin E and Gingko Biloba
S/E: bleeding, nausea, anxiety, GI disturbance, HA
58
Dementia Management of behavioral problems
Find underlying causes (overstimulation, medication, UTI, frustration)
Best communication
Stay calm, as your anxiety increases their anxiety
Do not try to talk out of hallucinations, but distract or use therapeutic touch
Identify and acknowledge feelings
Strategies for aggression/agitation
Do not try to physically restrain unless there is a safety concern
59
Sundown
Sx: increase in dementia symptoms in the late afternoon
Nursing intervention: management of behavioral problems and reorientation/distraction
60
What is respite care?
Having someone else care for the elder, a few hours each week can greatly decrease caregiver stress
61
What can care giver strain lead to?
At risk for further health complications
At risk for causing elderly abuse
62
Caregiver Stress and Impact on the lay caregiver
Resources for respite care
Self care techniques
63
Types of Elder Abuse
Physical: bruises, unexplained injuries, refusal to go to same ED for repeated injuries
Psychological/emotional: unresponsive, fearful, lack of interest, evasive
Financial/material: large withdrawals from accounts, signatures on checks don’t match
Sexual: perineal bleeding, bruised breasts
Caregiver neglect: sunken eyes, weight loss, extreme thirst, bed sores
64
Who is the victim and the usual abuser?
Highest percentage of elder abuse is neglect
Usual abusers: white males, 41-59 yrs old, elderly persons who give care, family members (adult children or spouses)
65
Who is at risk of elder abuse?
At risk: Highest risk are >80 yrs old, white female elders, elders who are unable to care for themselves, mentally impaired/confused, and depressed elders
Leads to abuse: abuser is dependent on victim financially, mental illness, drug abuse, living with elder, social isolation, continuation of domestic violence
66
What is the role of the nurse in Elder abuse?
Assessment Criteria
Interview patient and caregiver separately
Ask general screening questions, thorough history, complete physical/cognitive/emotional exam
Management/Intervention
Report the incident (this is mandatory)
If pt is in immediate danger, consider hospital admission with ICD code
If pt is not in immediate danger, consider lack of education and resources
Educate on respite care, social contact, and counseling
67
How do you “test” for depression?
Geriatric Depression scale (GDS) is used as a screening tool.
◦30-item (long) or 15-item (short).
◦Yes/No questions.
◦Pt. can complete alone, or have read to them.
◦Successfully distinguishes between non-/depressed older persons.
68
Is depression ever normal?
Yes
69
Medication used to treat depression?
SSRI (Escitalopram and Citalopram)
SNRI (Venlafaxine and Duloxetine)
Tricyclics (amitriptyline, nortriptyline, and doxepin)
MAOI (selegiline)
Atypical Antidepressants
70
Atypical Antidepressants
Vilazodine
Cannot use with SSRI/SNRI/MAOI
Avoid grapefruit juice
Take with food
Mirtazapine, reboxetine, and trazodone
71
What should you know about these antidepressant drugs?
SSRI and SNRI: **decrease sexual drive**, SI,
Serotonin Syndrome (HTN, dilate pupils, mental disorientation, diarrhea, HA) if severe (high fever, seizures, loss of LOC)
Tricyclics: **oHTN**, anticholinergic effect, sedation, avoid pregnancy, and toxicity (dysrhythmia, agitation, and confusion)
MAOI: do not give with other antidepressant, ***hold 10-14 days before surgery***, toxicity leading to dysrhythmias, sedation, and avoid tyramine rich food
72
Education about antidepressant drugs
SSRI: Slow onset and SE will wain over time (first 2 wks are the worst)
73
Duration of time to efficacy
It takes weeks to come into effect (uslly week 2-4)
