Sensory Pt 3 Flashcards by Christina Stafstrom

Member of the herpes group of viruses
Direct viral invasion of retinal cells
naturally occurring virus

Cyotomegalvirus (CMV) Retinitis

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who is CMV most common in

pts with HIV or that are immunocompromised

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what can CMV cause

blindness

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symptoms of CMV

Blurred vision
Decreased vision
Floaters
Blindness

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an exudative inflammatory process that involves retinal vessels

chorioretinitis

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managment of CMV

Gancyclovir (IV or PO)

Foscarnet (IV)

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carcinoma of the eye types

Choroidal melanoma
Iris melanoma
Retinoblastoma

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nursing diagnoses for eye problems

Disturbed sensory perception r/t visual deficit
Risk for injury r/t visual impairment
Self-care deficit r/t visual impairment
Anticipatory grieving r/t loss of functional vision loss
Acute pain r/t pathophysiologic process and/or surgical correction
Noncompliance r/t inconvenience of lifelong meds

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med for Acute closed-angle glaucoma

Osmotic (draws fluid into intravascular space to lower IOP)

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med for Corneal abrasion

Anti-inflammatory

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med for Ophthalmoscopy

Midriatic (pupil dilates, example is Atropine)

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med for Chronic closed-angle glaucoma

Miotic (constricts pupil and contracts the ciliary muscle allowing for enhanced circulation of aqueous humor)

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what percent of people with Down syndrome develop hearing loss in adulthood

70%

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what is important piece to ask during ear assessment

do you have dizziness or vertigo

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what does audiometry test

Pure tone (tests hearing threshold levels) 
Speech

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Artificial stimulation of the vestibular apparatus
Involves induced nystagmus (rapid involuntary movement of the eye)
Can suggest etiology of vertigo

Electronystagmography

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purpose of electronystagmography

determining if there is something wrong with the vestibular portion of the inner ear.

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If dizziness is not caused by the inner ear

it might be caused by disorders of the brain, or by medical disorders (low blood pressure)

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difficulty in the external ear or the middle ear);
i.e., problem conducting sound waves
Obstruction
Otosclerosis

conductive hearing loss

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overgrowth of bone in the inner ear

otosclerosis

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Root cause sometimes found in CN VIII, (Vestibulocochlear nerve)
Resulting from exposure to loud noises
Diabetes
Damage to inner ear
Meniere’s Disease
difficulty in the inner ear or the acoustic nerve

Sensorineural hearing loss

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Combination of conductive hearing loss and sensorineural hearing loss

mixed hearing loss

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PAIN
Itching or ear canal
Inflammation

external otitis

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why do kids often get outer ear infections

their ear canal is not sloped like in adults

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aka middle ear infection, is a common cause of hearing loss; trauma

Chronic otitis media

types of otitis media

Acute Chronic Serous

Performed if the perforation if only the membrane with no other accompanying damage

Myringoplasty

Performed if the middle ear is involved

tympanoplasty

post op considerations of ear surgery

``` Do not blow nose; sneeze or cough with mouth open Avoid physical activity for one week Keep ear dry for six weeks Do not shampoo hair for one week Avoid airplane travel for one week ```

Throbbing pain, drainage, fever, bulging tympanic membrane with possible perforation

otitis media

Hardening of the ear (stapes); normal canal and ear drum; progressive conductive hearing loss

otosclerosis

Most common blockage due to enlarged adenoid tissue

Eustachian tube disorders

inner ear infection | can be viral or bacterial

Labyrinthitis

a triad of symptoms – vertigo, dizziness, tinnitus, and hearing loss. Affects CN VIII

Meniere’s disease

Ringing noise

tinnitus

When eyes are open, world seems to be spinning

vertigo

Meniere’s Disease:Diagnosis

MRI and Audiometric testing

meniere's disease treatment

Bed rest during attack | Avoid sudden movement

meniere's disease meds

Dimenhydrinate (Dramamine) Cyclizine hydrochloride (Marezine) Meclizine (Bonine; Antivert; sedatives and hypnotics)

what is important to know about meniere's meds

make pt sleepy so watch for falls

how can you improve noise induced hearing loss

Tympanoplasty

Hearing loss related to aging More common after age 50 Hearing loss of higher frequencies Accompanied by tinnitis

presbycus

occurs suddenly usually in association with known trauma. signs of acute pain: sweating, pallor, perhaps nausea.

acute pain

develops over several days, often increasing in intensity with a pattern of progessive pain symptomatology. Typical cancer pain.

subacute pain

occurs over shorter periods of time at regular or irregular intervals. Arthritic pain that comes and goes is an example.

episodic pain

Pain that has persisted for more than 3 months.

chronic pain

example of things that cause chronic pain

Cancer, arthritis, fibermialga

Is the pain reported as an average pain intensity for 12 hours or more out of 24hrs.

baseline pain

pain more severe than the the baseline pain

breakthrough pain

pain occurring before the next dose of analgesics is due

end of dose pain

will decrease sensations in GI tract

narcotics

well-localized, sharp, aching, throbbing, pressure Inflammatory Muscular

somatic

Originates in internal organs diffuse, gnawing, aching, sharp, cramping, throbbing Referred pain

visceral

Nociceptive pain is receptive to what

opioids

Caused by an injury to the peripheral or central nervous system and causes a pain that is in excess of the initial injury

neuropathic pain

what fibers transmit pain

c fibers and A delta fibers-

morphine like substances are released from large diameter nerve fibers and close the gate

endorphins

gating mechanism occurs in the spinal cord, nerve fibers (A &C) transmit pain impulses to the dorsal horn of the spinal cord (substantia gelatinosa), where gating mechanism is, if gate is open, impulses go through, if not, no painful stimuli

gate control

what does chronic pain lead to

fatigue and sleep disturbances. | difficulty performing ADLs

what is the key to acute pain

when client unable to report unable to take deep breath, ambulate, sleep, perform ADLs Guarding, muscle tension or rigidity Autonomic changes with sudden and severe pain

how do you assess pain

``` PQRST Precipitating Quality Radiating Severity Timing ```

what is the WHO pain scale

1-4 scale | 1 is bottom (NSAIDS)

what is the bottom rung of ladder

(mild pain): Non opioid +/- adjuvant | ie/Aspirin, Ibuprofen (motrin), Naproxen (naprosyn)

second rung of ladder

worse pain): Weaker opioid +/- non opioid +/- adjuvant | ie/Codeine, Darvocet

highest rung of ladder

worst pain): Strong opioid +/- non opioid +/- adjuvant | ie/Morphine, Fentanyl, Oxy

why should you never take more than 4 g of tylenol a day

can cause severe liver failure and death

what causes severe constipation

morphine

describe Darvocet

very addictive-banned in US