Sensory Alterations

Question 0

Visual fields

Answer 0

Measurement of range of vision (perimetry)

Question 1

Tonometry

Answer 1

Measures intraocular pressure

Advise not to squint, cough, or hold breath during procedure

Question 2

Myopia

Answer 2

Nearsightedness

Question 3

Hyperopia

Answer 3

Farsightedness

Question 4

Presbyopia

Answer 4

With aging

Commonly occurs after age 35

Question 5

Agrigmatism

Answer 5

Uneven curvature of cornea causing blurring of Vision

Question 6

Conjunctivitis

Answer 6

Cause: bacteria, virus, allergies

Nursing considerations (NC)
Warm, moist compress, topical antibiotics, hydrocortisone

Question 7

Sty

Answer 7

Staphylococcal organism

NC- warm compresses, antibiotics, incision and drainage

Question 8

Chalazion

Inflammatory cyst

Answer 8

Duct obstruction

Incision and drainage

Question 9

Keratitis

Inflammation of cornea

Answer 9

Virus
Spread of systemic disease

Hot compress, steroids, except with herpes

Question 10

Uveitis

Inflammation of iris, ciliary body, choroid

Answer 10

Local or systemic infection

Question 11

Retinopathy of prematurity (ROP)

Answer 11

Assessment: demarcation line forms (separates avascular retina anterior lay with vascularized retina posteriorly)
Ridge forms
Retinal detachment
-can cause blindness in premature infants
High concentration of oxygen cause the premature infants retinal vessels to construct, causing blindness

Sometimes causes when oxygen concentrations are greater then 40% and when used longer than 48-72 hours in infants

Question 12

Strabismus

Answer 12

Assessment: visible deviation of eye
Diplopia
Child tilts head or squints

Imbalance of extraocular muscles

Plan/implementation
No surgical intervention begins no later than age 6
Occlusion of unaffected eye to strengthen weaker eye
Orthotic exercises

Question 13

Detached retina

Answer 13

Assessment-
Flashes of light
Blurred or sooty vision
Sensation of particles moving in line of vision  
A feeling of curtain coming up or down 
Loss of vision
Confusion

Causes:: trauma, aging, diabetes, tumors

Plan: bed rest, do not bend forward, avoid excessive movements.
Affected eye or both eyes must be patched to decrease movement of eye
Avoid strenuous activity for 3 months after surgery( air bubble used to apply pressure to retina)

Question 14

Cataracts

Answer 14

Objects appear distorted and blurred; decreased color perception.
Annoying glare, double vision
Pupil change from black to gray to milky white

Plan: laser surgery
Complication:: hemorrhage- sudden sharp pain
Increased intraocular pressure

Question 15

Glaucoma

Answer 15

Cloudy, blurry vision or loss of Visio.
Artificial lights appear to have rainbows or halos around them
Decreased peripheral vision
Pain, headache
Nausea, vomiting
Types:: angle closure- sudden onset, emergency- associated with emotional disturbances, allergy, vasomotor disturbaces
Open-angle (primary glaucoma)
Blockage of aqueous humor flow)- associated with trauma, hemorrhage, iritis, aging
Plan::
Medications:: prostaglandin agonists, adrenergic agonists, beta-adrenergic blockers, cholinergic agonists, carbonic anhdrase inhibitors
To keep angle open

Surgery- laser trabeculoplasty
Avoid use of mydriatics (atropine)- which can close angle

Educate public to 5 danger signs of glaucoma: continues brow arching, halos around light, blurry vision, diminished peripheral vision, headache or eye pain

Question 16

Hearing loss

Conductive

Answer 16

Conductive loss- assessment
Pain, fever, headache, discharge, altered growth and development, personality changes

Caused:: infection, inflammation, foreign body, trauma, ear wax
Complications- meningitis resulting from initial infection
Diagnostic-
Audiogram (quantitative)-degree
Tuning fork (qualitative)-type

Question 17

Hearing loss

Perceptive (sensorineural)

Answer 17

Assessment- pain, fever, discharge, altered growth and development, personality changes, depression, suspiciousness, withdraw

Due to disorder of the organ of corti or the auditory nerve
Causes- congenital, infection, trauma, labyrinth dysfunction- menieres disease

Question 18

Ear drop for adult

Answer 18

Pull upward and backward

Question 19

Ear drop in child

Answer 19

Pull Downward and backward

Question 20

Ménière’s disease

Answer 20

Assessment- nausea, vomiting, incapacitating vertigo, tinnitus, feeling of pressure, fullness in ear. Fluctuating, progressive decreased hearing on involved side, nystagmus, headache

Diagnose:: dilation of the membrane of the labyrinth.
Recurrent attacks of vertigo with sensorineural hearing loss
Attacks recur several times a week, periods of remission may last several years.
Diagnostics tests- we ER and rinne test, CT
Drug therapy- antihistamine in acute phase, antiemetics, anti vertigo meds (valium, raglan, tigan) and diuretics.
Low sodium diet, avoid caffine, nicotine, alcohol

Question 21

Acute otitis media

Answer 21

Infection in middle ear
From pathogenic organisms
Assessment- ringing in ear, fever, headache, head Rolling, crying, ear tugging (kids)
Red bulging tympanic membrane
Plan- administer antibiotics, antihistamines, nasal decongestant

Myringotomy- tympanic meme tame incision to relieve pressure and release purulent fluid
Tympanoplasty- surgical reconstruction of ossicles and tympanic memenrane

Question 22

Trigeminal neuralgia

Answer 22

Aka tic douloureux
Involves one or more branches of the Fifth cranial nerve causes, infections of sinuses, teeth, mouth, or irritation of nerve pressure.

Assessment:: stabbing are burning facial pain- excruciating, unpredictable, paraxysmal twitching, grimacing of facial muscles.

Nursing consideration- identify and avoid stimuli that exacerbate the attacks administer medications: carbamazepine (tegretol)- anti-seizure meds, and analgesics
Treatment- tegreto, alcohol injection to nerve, resection of the nerve, mucrocascular decompression

Use warm instead of hot wash clothes, chew on Uneffected side

Question 23

Bell’s palsy (facial paralysis)

Answer 23

Assessment::
Inability to close eye 
Decreased corneal reflex
Increased lacrimation
Speech difficulty
Loss of tAste
Distortion of one side of face 
Analysis:: peripheral involvement of the seventh cranial nerve
Predisposing factors- vascular ischemia, viral disease, edema, inflammatory reactions.

NS::
Protect head from cold or drafts. Administer analgesics.assist with electric stimulation. Tech isometric exercises for a facial muscles (below and suction from a straw).
Massage, warm packs, provide emotional support for altered body image. Prevent corneal abrasion’s( artificial tears)
Treatment- electrical stimulation, analgesics, steroid therapy, antiviral medications, recovery takes 3 to 5 weeks

Question 24

Acoustic neuroma

Answer 24

Assessment- deafness, partial, initially twitching, grimacing of facial muscle dizziness

Analysis- benign tumor of the eighth cranial nerves

NS-
Pre-and post operative care for posterior fossa craniotomy
Comfort measures/assist with turning of head and neck. Treatment- surgical surgical excision of tumor

Question 25

Guillain-Barré syndrome

Answer 25

Assessment- 1)parenthesis pain often occurring in glove-and-stocking distribution; pain
2)Motor losses symmetrical, is a beginning and lower extremities, then extend upward to include trunk, upper chimneys, cranial nerves, and vasomotor function; deep tendon reflexes disappear; respiratory muscle compromise.
3) excessive or inadequate autonomic dysfunction
A. Hypotension, tachycardia
B. Vasomotor flushing
C. Paralytic ileus
D. Profuse sweating
4) progression period- average 10 days, with duration of maxim symptoms of 10 days
5) recovery period- several months to a year, 10% residual disability

Question 26

Guillain-Barré syndrome

Diagnose

Answer 26

1)Progressive inflammatory autoimmune response occurring in peripheral nervous system, Resulting compression of the nerve roots and peripheral nerves, demyelination occurs slows are alters nerve conduction

2) possible causes
A. Infective, viral
B. Autoimmune response
C. May follow immunizations
3) course
A. Acute, rapidly ascending sensory and motor deficit that may stop at any level of the CNS
B) protracted, develops slowly, regresses slowly
C) prolonged course with phases of deterioration and partial remission

Question 27

Guillain-Barré syndrome plan/implementation

Answer 27

1) intervention is symptomatic
2) steroids in acute phase
3) plasmapheresis, IV immunoglobuns, adrenocorticotropic hormone, corticosteroids
4) mechanical ventilation, elevate head of bed, suctioning
5) prevent hazards of immobility
6) maintain adequate nutrition, hydration
7) physical therapy, range of motion
8) pain reducing measures
9) eye care
10) ) Prevention of complications– UTI, aspiration, constipation, urinary retention

Can be complete recovery, but depends on how good nursing care was

Question 28

Meningitis

Assessment

Answer 28

1) headache, fever, photophobia
2) signs of meningeal irritation
A. Nuchal rigidity-stiff neck
B. Kernigs sign- when hip is flexed to 90 degrees, complete extension of the knee is restricted and painful
C. Brudzinski’s sign- attempts to flex the neck will produce flexion at knee and thigh
D. Opisthotonic position- extensor rigidity with legs hyperextended and forming an arc with trunk
3) chances in loc
4) seizures
5) symptoms in infants: refuse feedings,vomiting, diarrhea, bulging fontanalles, vacant stare, high-pitched cry

Question 29

Meningitis implementation

Answer 29

IV antibiotic therapy- penicillin, cephalosporin, vancomycin

Monitor ABG, arterial pressures, body weight, serum electrolytes, urine volume, specific gravity, osmolality (SIADH can occur)

Droplet precautions

Question 30

Migraine headache meds

Answer 30

Beta blockers, triptan preparations- activate serotonin receptors
Acetaminophen, NSAIDs,topiramate (topamax), ergotamines- dihydroergotamine (DHE), take at start of headache

Question 31

Migraine assessments–

Answer 31

Prodromal (indicating onset)- depression, irritability, feeling cold, food cravings, anorexia, change in activity level, increased urination
Aura- light flashes and bright spots, numbness and tingling (lips, face, hands), mild confusion, drowsiness, dizziness, diploplia (double vision)

Question 32

Huntingtons disease

Answer 32

Assessment- depression and temper outburst
Choreform movements (constant movements)
-slight to severe restlessness
-facial grimacing
-arm movements
Personality changes
Diagnose:: rare, familial progressive, degenerative disease that is passed from generation to generation (dominant inheritance- only one allele is required)
Plan- drug therapy to intend to reduce movement and subdue behavior changes (Librium, haldol, Thorazine)
Supportive, genetic counseling