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Med Surg 1 > SN/CVA exam 4 questions > Flashcards

SN/CVA exam 4 questions Flashcards

1
Q

how would a patient present with AMD

A

loss of central vision

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2
Q

how would a patient present with glaucoma

A

peripheral vision loss

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3
Q

how would a patient present with cataracts

A

opacity of lens – can be bilateral or unilateral

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4
Q

what medications treat symptoms of glaucoma by lowering IOP

A

cholinergic
prostaglandin analogs
beta blockers
alpha-adrenergic agonists
carbonic anhydrase inhibitors

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5
Q

there is no cure for glaucoma so the medications treat symptoms and prevent ___ ____ _____

A

optic nerve damage

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6
Q

SE/CI of cholinergics

A
  • expire after 2 months at room temp
  • tell pt to avoid dimly lit areas
  • side effects = pain and blurred vision
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7
Q

prostaglandin side effects

A

darkening of iris

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8
Q

beta blocker contraindications

A

COPD, asthma, heart blocks, bradycardia

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9
Q

alpha agonists side effects

A

redness of eyes, dry mouth, dry nasal passages

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10
Q

carbonic inhibitors important infor

A

avoid with sulfa allergy and watch for electrolyte imbalances

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11
Q

signs/symptoms of retinal detachment

A

Sudden floaters, flashes, blurred vision, reduced peripheral vision, curtain-like shadow over field of view

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12
Q

type of conjunctivitis associated with a history of URI

A

viral (adenovirus, H. simplex)
very contagious!!!

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13
Q

how to instill eye drops or ointment for conjunctivitis

A

Apply drops to inner canthus

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14
Q

What side effects can occur with someone who is having cerumen impaction irrigation?

A

Vertigo/dizziness
Perforation of tympanic membrane

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15
Q

what condition can cause tympanic membrane perforation

A

acute and chronic otitis media

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16
Q

Meniere’s disease has what 3 symptoms

A

vertigo, tinnitus, hearing loss

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17
Q

medical treatment for Meniere’s

A

Antihistamines (Antivert)
Tranquilizers (valium)
Antiemetics (Phenergan)
Diuretics
Shunting of the fluid or vestibular nerve suctioning (surgical)

18
Q

nonmedical treatments for Meniere’s disease

A

Low salt diet (1000-1500 mg daily)
Increase water intake
Avoid caffeine
Limit alcohol intake
Avoid aspirin and MSG

19
Q

Describe a patient who is at high risk for CVA. Age/race/medical conditions

A

African American
Male
Over the age of 55
History of HTN
HLP
Diabetes
Atrial fibrillation
Cardiomyopathy
Sickly cell disease
Migraines
Obstructive sleep apnea
Lupus
Rheumatoid arthritis

20
Q

what focused assessments should be performed on a pt who presents with possible CVA

A

Gag reflex
Respiratory pattern
Blood pressure
Carotid exam
Gross neurological deficits (cranial nerves)
Mental status (sensorium)
NNHS score

21
Q

what imaging study is necessary to diagnose CVA to differentiate between hemorrhagic and ischemic

A

CT scan – view tissue

22
Q

beneficial diagnostic studies in identifying cause of CVA

A

MRI – view vessels
carotid ultrasound – carotid bruit/blockage
EKG – AFIB

23
Q

emergent treatment of ischemic stroke

A

tPA

24
Q

goal of tPA

A

dissolve clot; restore blood flow to brain regions affected by a stroke

25
Q

what info is needed prior to administering tPA

A

time of onset of stroke symptoms

26
Q

How often should the patient be reassessed with tPA

A

every 15 minutes for the first 2 hours

27
Q

complication of tPA

A

worsening bleeding in the brain

28
Q

patients who CANNOT have tPA

A
  • Symptoms started more than 3 hours ago
    - INR greater than 1.7 (warfarin)
    - Previous head trauma/injury less than 3 months ago
    - CVA less than 3 months ago
    - GI bleed less than 3 months ago
    - Pregnant
    - Hypotension (tPA will lower BP)
    - Thrombocytopenia
    - Major surgery less than 14 days prior
    - Foley catheter, IVs
29
Q

what should the nurse do if the patient could not have tPA and has ICP

A

mannitol

30
Q

Describe non-emergent medical and management treatment for those who had CVA

A

Treat the underlying cause of the stroke – HTN, HLP, AFIB, and alcohol/tobacco use

Use anticoagulants and platelet inhibitors for drug tx

31
Q

nursing considerations of post op carotid endarterectomy

A

Monitor for bruising and edema around the neck and monitor breath sounds

Avoid disturbances of the incision

Stroke, cranial nerve injury, infection, bleeding

Neuro checks to assess for nerve damage as well as possible stroke

32
Q

ischemic stroke symptoms

A

confusion
AMS
loss of balance, coordination, dizziness
perception disturbances
emotional lability/depression
inappropriate emotional response (PBA

33
Q

hemorrhagic stroke symptoms

A

sudden HA
N/V
sudden LOC
seizures
nuchal rigidity
hemiparesis

34
Q

symptoms of both ischemic and hemorrhagic strokes

A

Hemiplegia – paralysis
Hemiparesis – weakness
Dysarthria – difficulty talking
Dysphagia – impaired speech
Expressive inability
Receptive inability
Hemianopsia – loss of half of vision field in eye on affected side
Apraxia – can’t recall learned skills
Agnosia – cant recognize an object

35
Q

4 complications of a hemorrhagic stroke

A

rebleed
hematoma
hydrocephalus (ICP)
hypoxia

36
Q

nursing interventions rebleed

A

watch for bleed
avoid anticoagulants

37
Q

nursing interventions hematoma

A

avoid anticoagulants

38
Q

nursing interventions hydrocephalus

A

CSF drainage
ventricular shunt
mannitol
HOB at 30 degrees
avoid hypo/hyperglycemia

39
Q

nursing interventions hypoxia

A

proper oxygenation/ventilation

40
Q

how to prevent vasospasm after hemorrhagic stroke

A

control BP with calcium channel blocker or triple h therapy

41
Q

CCB used for vasospasm prevention

A

Nimodipine (nymalize)

42
Q

what is triple H therapy and why is it used

A

hypervolemia (fluid volume expanders), induced hypertension, + hemodilution

used to avoid hypotension (and hypertension)

Med Surg 1 (5 decks)

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