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PCC 2 Final > PCC 2 Exam 3 > Flashcards

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.

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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

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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

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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

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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

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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

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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

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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

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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

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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

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11
Q

What is glaucoma?

A

A disturbance of the functional or structural integrity of the optic nerve.

Irreversible

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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

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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

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14
Q

What are the medication for Gluacoma?

A

Beta-blockers (timolol)
Adrenergic (lopidine, alphagan)
Miotic/Cholinesterase Inhibitors (pilocarpine)
Carbonic anhydrase inhibitors
Prostaglandin analogues

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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)

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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

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17
Q

Adrenergic (lopidine, alphagan)

A

Client education:

Alert MD if experience palpitation, HTN, tremors, sweating

Nursing implications

Monitor VS, neuro function, respiratory status

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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

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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

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18
Q

Detached Retina Corrective Procedure

A

Gas bubble: helps to push retina back to the wall of the eye so it can reattach

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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

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19
Q

Macular degeneration Types

A

Dry: atrophy

Wet: exudate

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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

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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

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21
Q

Mydriatics

A

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

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21
Q

Macular Degeneration Teaching

A

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)

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22
Q

NSAID

A

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.

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22
Q

Drugs that have risk for Hearing Loss

A

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

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23
Q

Corticosteroids (prednisolone)

A

Post-op Cataract

Client education

Alert MD if pressure around eye or edema

Nursing implications

Instruct on importance of med adherence

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23
Q

Hearing Aid Care

A

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

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24
Q

COPD Diagnosis

A

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

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24
Q

Antibiotics

A

Post-op Cataract

Client education

Alert MD of sx of infection

Nursing implication

Importance of med adherence

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25
Q

Cataract complications

A

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

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25
Q

COPD assessment

A

Baseline, edema, JVD, elevated VS, and use of accessory muscles

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26
Q

Detached Retina S/S

A

curtain like shadow over visual field, sudden appearance of floaters, flashes of light in one or both eyes, blurred vision, gradually reduced peripheral vision

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26
Q

COPD Causes

A

3 factors: fluid build up, inflammation, and bronchoconstriction

Emphesema does not have fluid (mucus) build up

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27
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

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27
Q

Difference between chronic bronchitis and emphysema

A

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

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28
Q

Detached Retina corrective procedure

A

Gas bubble: helps to push retina back to the wall of the eye so it can reattach

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28
Q

Emphysema (pink puffer) definition

A

Abnormal or permanent enlargement of the airspace (no mucus)

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29
Q

Macular Degeneration Types

A

dry and wet

Dry: atrophy

Wet: exudate

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29
Q

Chronic Bronchitis (Blue Bloaters) Definition

A

Chronic productive cough for three months

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30
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

30
Q

Management of COPD and Asthma Exacerbation

A

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
Q

Macular Degeneration Client Teaching

A

wear UVA/UVB protection
Diet and Supplements

31
Q

Emphysema Dyspneic Episode Intervention

A

Tripod position, administer bronchodilator, diaphragm and purse lip breathing, encourage alternating activity with rest period, and teach techniques of chest physiotherapy

32
Q

Macular Degeneration Diet and Supplement

A

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
Q

Asthma Diagnosis

A

PFT, X-ray for fluid development, sputum culture, normal FEV1/FVC 70-75%

33
Q

Hearing Loss Risk factor

A

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
Q

Asthma Management

A

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
Q

Drugs with risk of hearing loss

A

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
Q

Management of COPD

A

Prevent disease progression, relieve symptoms, improve exercise tolerance, improve health status, prevent and treat exacerbations, reduce mortality

35
Q

Hearing Aid Care

A

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
Q

COPD Exacerbations

A

Most common cause is infection and air pollution
Usually benefit from use of bronchodilators, oral steroid, and antibiotics

36
Q

Hearing Loss communication

A

Cochlear implants, assistive listening devices (amplifier, telephone devices)

36
Q

Pulmonary rehabilitation

A

Improvement of QOL through breathing, relaxation techniques, smoking cessations, energy conservations, exercise, and group support

37
Q

COPD diagnosis

A

Diagnosis

Cannot perform PFT during exacerbation (FEV1/FVC ratio is < 70%)

37
Q

Oxygen Toxicity

A

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
Q

COPD assessment

A

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
Q

COPD Complication and education

A

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
Q

What are the three constrictive diseases causes of COPD?

A

Emphysema (pink puffer)
Chronic Bronchitis (blue bloater)
Asthma

39
Q

Beta 2 - adrenergic agonist

A

Albuterol: inhaled = short acting
Terbutaline: PO = short acting
Salmeterol, Formoterol: inhaled = long acting

40
Q

What is emphysema and S/S?

A

Abnormal and permanent enlargement of the airspaces (no mucus)

Sx: older, thin, dyspnea, quiet chest, barrel chest, tripod

40
Q

COPD Long term Control

A

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
Q

What is dyspneic episode and what to do in a dyspneic episode?

A

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
Q

COPD relievers

A

Short-Acting Beta Agonists - Albuterol

Complication: Tachycardia and tremors

42
Q

Chronic Bronchitis (blue bloater) s/s

A

Chronic productive cough for three months

Sx: overweight, cyanotic, elevated hemoglobin, peripheral edema, rhonchi, wheezing, prolonged expiration, clubbing

42
Q

COPD Controllers

A

Long-Acting Beta Agonists - Salmeterol and formoterol

43
Q

Asthma Causes

A

Mucosal edema (inflammation), bronchoconstriction, and excessive mucus production

43
Q

COPD preventers

A

Fluticasone and Beclomethasone

44
Q

Asthma Diagnosis

A

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
Q

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

A

Answers 1, 2, and 4.

45
Q

Asthma Management

A

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
Q

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
A

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
Q

Asthma Education

A

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
Q

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

A

Answer: 3 An increase in the rate of respirations and a decrease in the depth of respirations together indicate deterioration in ventilation.

47
Q

Asthma Management objectives

A

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
Q

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

A

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
Q

Asthma Pulmonary rehabilitation

A

Improves QOL through breathing, relaxation techniques, smoking cessation, energy conservation, exercise, and group support

48
Q

Normal Neurologic changes in aging.

A

Everything cognitive decreases except for pain threshold

49
Q

Asthma Oxygen therapy

A

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
Q

Dementia Diagnosis

A

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
Q

Asthma Client education

A

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
Q

Mini-Cog exam

A

three-item recall and a clock drawing test to determine easily and quickly detect dementia

A positive mini-cog indicate further assessment

51
Q

The Mini-Mental Exam

A

Determines level of cognitive impairment and not dementia severity. It is usually used for cognitive impairment test

52
Q

FAST Scale

A

The higher the number, the more assistance they would need (about 4+)

Once they are in 4, they will need help with ADL

53
Q

Difference between Dementia and Depression

A

If person is responding appropriately to questions, then it indicates depression

If patient is not responding appropriately to question, then it indicate dementia

54
Q

Know Alzheimer’s drug and when they are used in the progression of the disease

A

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
Q

What medication is used for mild-moderate Dementia?

A

Cholinesterase Inhibitors

Donepezil (aricept) - can also be used for moderate to severe dementia
Rivastagmine (exelon)
Galantamine (Razadyne)

56
Q

What to use for Moderate to Severe Dementia?

A

Memantine (Namenda)
Can be added with other medication

57
Q

Complimentary antioxidants for Dementia

A

Vitamin E and Gingko Biloba

S/E: bleeding, nausea, anxiety, GI disturbance, HA

58
Q

Dementia Management of behavioral problems

A

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
Q

Sundown

A

Sx: increase in dementia symptoms in the late afternoon

Nursing intervention: management of behavioral problems and reorientation/distraction

60
Q

What is respite care?

A

Having someone else care for the elder, a few hours each week can greatly decrease caregiver stress

61
Q

What can care giver strain lead to?

A

At risk for further health complications

At risk for causing elderly abuse

62
Q

Caregiver Stress and Impact on the lay caregiver

A

Resources for respite care

Self care techniques

63
Q

Types of Elder Abuse

A

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
Q

Who is the victim and the usual abuser?

A

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
Q

Who is at risk of elder abuse?

A

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
Q

What is the role of the nurse in Elder abuse?

A

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
Q

How do you “test” for depression?

A

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
Q

Is depression ever normal?

A

Yes

69
Q

Medication used to treat depression?

A

SSRI (Escitalopram and Citalopram)
SNRI (Venlafaxine and Duloxetine)
Tricyclics (amitriptyline, nortriptyline, and doxepin)
MAOI (selegiline)
Atypical Antidepressants

70
Q

Atypical Antidepressants

A

Vilazodine
Cannot use with SSRI/SNRI/MAOI
Avoid grapefruit juice
Take with food

Mirtazapine, reboxetine, and trazodone

71
Q

What should you know about these antidepressant drugs?

A

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
Q

Education about antidepressant drugs

A

SSRI: Slow onset and SE will wain over time (first 2 wks are the worst)

73
Q

Duration of time to efficacy

A

It takes weeks to come into effect (uslly week 2-4)

PCC 2 Final (2 decks)

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