Safety & Risk video Flashcards
(ROP) Retinopathy of Prematurity
high concentrations of oxygen cause premature infant retinal vessels to constrict O2 > 40% or O2 at high levels for more than 48-72h Can cause retinal detachment
manifestations of detached retina
flashes of light blurred vision loss of vision particles moving in vision field (floaters) feeling of curtain coming down confusion, apprehension
Cataracts
distorted, blurred vision glare, double vision milky white pupil Post-op: Pt should sleep on unaffected side and wear night shield Pupil is constricted if new lens implanted, dilated if no implant sudden pain post-op may be hemorrhage
Glaucoma
abnormal increase in IOP -is an obstruction of outflow of aqueous humor -open is gradual onset -closed is sudden onset (allergy or vasomotor disturbance) assessment: brow arching blurred vision lights with halos decreased peripheral vision (tunnel) pain, h/a N/V Avoid Atropine, will close the angle
conductive vs sensorineural loss
conductive loss: d/o in auditory canal, ear drums, ossicles (d/t infection, inflammation, foreign body, trauma, ear wax)
sensorineural: d/o of organ of Corti or auditory nerve (d/t drug toxicity, trauma, congenital)
Administer ear drops: up or down
Adult: pull up on ear and backward
Child: pull down on ear and backward
Based on position of eustachian tube
Otitis media (middle ear infection)
bright red tympanic membrane
fluid filled
Need to position on affected side for drainage
may need ventilatory tubes (myringotomy) –> must avoid water in ear (bath/swimming)
Meniere’s disease
Meniere’s disease is a disorder of the inner ear that causes spontaneous episodes of vertigo — a sensation of a spinning motion — along with fluctuating hearing loss, ringing in the ear (tinnitus), and sometimes a feeling of fullness or pressure in your ear.
Bell’s Palsy
damage to cranial nerve 7 (facial)
- inability to close eye, increased lacrimation
- distorted side of face, speech difficulty
**NOT PERMANENT
Steroid use necessary.
Acoustic neuroma
cranial nerve 8 affected by tumor
need posteriorfasa craniotomy (at base of neck)
trigmeminal neuralgia
cranial nerve 5
is a nerve responsible for sensation in the face and motor functions such as biting and chewing.
Guillain–Barré syndrome
Guillain-Barre syndrome is a serious disorder that occurs when the body’s defense (immune) system mistakenly attacks part of the nervous system. This leads to nerve inflammation that causes muscle weakness and other symptoms.
PARALYSIS STARTS FROM PERIPHERY AND MOVES UP TO THE TRUNK
Meningitis
Lumbar puncture performed to determine the cause…
Assessment:
- nuchal rigidity
- Kerning’s sign: hips are flexed and knees can’t straighten w/o pain
- Brudzinski’s sign: can’t do chin to chest
- Change in LOC, seizures
- Infant: bulging fontanels, high pitched cry
**Can cause SIADH- so monitor electrolytes, urine volume, specific gravity
**DROPLET PRECAUTIONS!!!
Migraine headache prevention and tx
Ergotamines are taken AT THE START of onset
Medications: aspirin a day, beta adrenergic blockers, ca channel blockers (relax smooth muscles); others are NSAIDs
Huntington’s dz
It is an autosomal dominant disorder.
rare familial, progressive, degenerative disease that’s passed from generation to generation
- Pt start w/ depression and personality changes, then develop choreiform movements, which is constant movement, repetitive movement
- Korea is used to describe Huntington’s dz
- may start as restlssness, facial grimacing, arm and leg and tongue movements and can progress to constant mvmt by end of dz progression
- Pt will become increasingly debilitated and unable to care for himself
- aspiration and respiratory failure are usually causes of death
NO SURE, CARE IS SUPPORTIVE.
Diabetes Mellitus symptoms (regardless of type)
polyuria
polydipsia
polyphagia
weight change (loss or gain)
onset of DM Type 1 & 2
Type 1 (5% of population):
acute onsdet before age 30, beta cells destroyed and insulin required
ketosis prone, body breaks down fat when no insulin available
Type 2 (95% of population):
insidious onset after age 30, often related to obesity, causing insulin resistance
DM type 2 risk factors
- parents or siblings with type 2 DM
- obesity
- African Am, Native Am, Hispanic Am, Asian Am
- age > 45 years old
- hypertension
- hx of GDM
diagnostic tests for DM
- FBS 60 - 110
- GTT measures how the body responds to 75g of oral glucose, tested at timed intervals (before, 1h, 2h- should be less than 140 at 2h)
- 140-200 impaired glucose
- >200 diagnoses DM
- HbA1c tells glucose over past 3 months
How does insulin work?
facilitates uptake and utilization by muscles and fat cells
decreases release of glucose in the liver and lowers blood glucose
how should insulin be mixed?
clear before cloudy
Regular before NPH
(because you would never want to accidentally put long acting NPH in short acting bottle, which could be detrimental to pt if pt things they are administering short acting)
Sick day rules for insulin
sickness elevates blood glucose levels
- take insulin as ordered
- check more frequently, may need to increase dose
- check urine for ketones
- If vomiting, diarrhea, or fever; report to HCP and take liquids q30m or q1h
diabetes foot care
inspect feet daily
wear well fitting shoes (shop for shoes when feet are largest late in the day; break in new shoes slowly)
don’t walk barefoot or use heat pad
cut toenails straight across
Assessment and Implementation
of DKA
Assessment:
- blood sugar 300 - 800
- headache
- drowsiness, weakness
- skin warm and dry (sugar high), elevated temp
- fruity odor
- Kussmal’s respirations (body trying to rid acids that are forming)
Implementations:
- Major complication: fluid volume deficit (major dehydration)
- replace 0.9NS or 1/2NS
- regular insulin IV 5units/hr
- Potassium replacement or EKG (hypokalemia)
- assess VS q15min until stable
HHNKS
(hyperglycemia hyperosmolar nonkeotic syndrome)
- glucose > 800
- associated with type 2 DM
- hypotension
- dry mucous membranes
- seizures
- ketosis, acidosis don’t occur b/c pt has some insulin (unlike type 1 DM patients)
Care of pt with Hiatal Hernia
small, frequent feedings
do not lie down 1h after eating
elevate head when sleeping
Meds: antacids, h2 receptor blockers, cytoprotective agents
CARAFATE: coats the stomach (SO GIVE ON EMPTY STOMACH prior to ingestion of food)
Chronic duodenal ulcer
male, 30-60yo
low gastric pH, hypersecretion
pain 2-3h after or at night (b/c stomach empty!)
food intake relieves pain
rarely malignant
chronic gastric ulcer
age 50 and older (no difference in male/female)
normal gastric pH
pain 30min to 1h after meals or when fasting
pain relieved by vomiting (eating makes worse)
tendency to be malignant
Change in diet for ulcers
eat 3 meals per day
avoid coffee, alcohol, caffeine, milk, cream
avoid food extremes in temperature
reduce stress and stop smoking
Ulcer medications
- Antacids 1h before or after meals
- Histamine receptor blockers (Tagamet): Take with meals
- Anticholinergics: give 30min before meals
- Cytoprotectives: Carafate will coat ulcer
- Proton pump inhibitors
Billroth I & II
Removal of part of the stomach
II is more complicated
Crohn’s dz versus Ulcerative Colitis
Crohn’s disease (affects ileum)
- slowly progressive, lesions separated by normal tissue (regional)
- age 20-30 and 50-80
- steathorrhea
- colicky abdominal pain after meals
- have 5-6 unformed stools/day (diarrhea rare)
- weight loss, anemia, dehydration
- fistula formation common
Ulcerative Colitis
- begins in rectum w/ continuous segments involving mucosa layer
- age 30-50
- no fat in stool
- rectal bleeding is common
- abdominal pain pre-defecation
- diarrhea 10-20 liquid stools/day, often bloody
- weight loss, anemia, dehydration
- fistual formation RARE
- remission and relapses
Diverticular disease
- pain in LLQ
- relieved by passage of stool, flatus
- constipation alternating with diarrhea
- dietary deficiency of fiber
- avoid food w/ seeds
- need high fiber diet to promote bowel movement
Appendicitis
- pre-umbilical abdominal pain shifts to RLQ (McBurney’s point)
- localized tenderness
- anorexia, N/V
- muscle guarding, low grade fever, WBC is 15-20k
Implementation:
- no analgesics to mask the pain b/c when it ruptures pain is suddenly relieved (which can cause peritonitis)
- no heating pads, enema, or laxative
- NPO
- Fowler’s position post-op
Peritonitis
inflammation of part or all of abdominal cavity
- severe abdominal pain
- abdominal rigidity, rebound tenderness
- N/V
- ascites
- fever, leukocytosis
- decreased bowel sounds –> paralytic ileus
Hirschsprung’s dz
missing nerve cells in the muscles of part or all of the intestine, no peristalsis
newborn: failure to pass meconium, refusal to suck
child: failure to gain weight, foul stools, constipation
abdominal distention
Intestinal Ostomies
Postop: Intestinal ostomies for fecal diversion
- NG tube, NPO until peristalsis
- Clear liquids progressing to solid, low-residue diet first 6-8wks
- Monitor I&O and F&E balance
- Condition of stoma
- first few days: beefy red, swelling should go down
- notify HCP if dark blue or purple
- Drainage is usually mucous for first few days and will start to function about 3-6 days after surgery
poop consistency in colostomy
Upper intestinal:
- lots of liquid stool, and gastric and pancreatic gas secretions
-
Ileostomy: liquid, odorous, highly corrosive drainage (don’t want to touch skin), remove contents 2-4x day w/ catheter; low-residue diet, no corn or nuts
- pt has no control over when BM will occur
Colon:
- water is pulled out so softer stool
- Transverse colostomy: soft to fairly firm, very foul smelling and corrosive drainage, pouch should always be worn, diet not restricted after 6wks
Sigmoid colon:
- more formed
- Descending or Sigmoid colostomy: firm stool, foul smelling, fairly corrosive; may wear pouch and control with colostomy irrigation; diet not restricted after 6wks
- irrigation begins 5-7d postop, warm water infused 5-10min and drained 10-15min. (irrigation cone used and inserted 3inches)
manifestations and complications
of cirrhosis
Manifestations
- indigestions, N/V
- flatulence, constipation, diarrhea
- anorexia, weight loss
- esophageal varices
- ascites, anemia
- jaundice, pruritus
- dark urine (tea colored), clay-colored (light) stool
Complications
- Peripheral edema and ascites- dehydration and hypokalemia
- Hepatic encephalopathy- accumulation of ammonia
- asterixis- flapping tremor of hand
- disoriented–> comatose
- Hepatorenal syndrome
- azotemia
- renal failure
Types of cirrhosis
- Laennec’s - due to alcoholism and poor nutrition
- Biliary - due to chronic biliary obstruction and infection
- Post-necrotic - due to previous viral hepatitis
Cirrhosis: dietary needs
Early: high protein, high carbohydrate diet
Advanced stage: restrict fiber, protein, fat, sodium
avoid alcohol
sodium and fluid restrictions
monitor for bleeding
Reye’s Syndrome
no aspirin for child with URI or gastroenteritis
Assessment:
fever, increased ICP, decreased LOC, decreased hepatic fxn
dx by liver biopsy
Pancreatitis
Assessment
- severe abdominal pain
- N/V 24-48h after a heavy meal/alcohol
- hypotension, acute renal failure
- elevated serum amylase
- hyperglycemia
acute glomerular nephritis
caused by antigen reaction to the strep bacteria
Scabies
Manifestations and tx
assessment:
- minute, reddened, itchy lesions
- severe itching, especially at night
implementation:
- topical antipruritic
- skin precautions necessary
- isolate the laundry b/c mites could be on it
- rash may continue 2-3 weeks
Eczema
In children: dry, red skin lesions that weep and crust
In adults: hard, dry, scaling patches
Need to eliminate to prevent exacerbations:
- milk, eggs, wheat, citrus
- cotton clothing
- soap
Apply lotion, topical steroids
