SN/CVA exam 4 questions Flashcards
how would a patient present with AMD
loss of central vision
how would a patient present with glaucoma
peripheral vision loss
how would a patient present with cataracts
opacity of lens – can be bilateral or unilateral
what medications treat symptoms of glaucoma by lowering IOP
cholinergic
prostaglandin analogs
beta blockers
alpha-adrenergic agonists
carbonic anhydrase inhibitors
there is no cure for glaucoma so the medications treat symptoms and prevent ___ ____ _____
optic nerve damage
SE/CI of cholinergics
- expire after 2 months at room temp
- tell pt to avoid dimly lit areas
- side effects = pain and blurred vision
prostaglandin side effects
darkening of iris
beta blocker contraindications
COPD, asthma, heart blocks, bradycardia
alpha agonists side effects
redness of eyes, dry mouth, dry nasal passages
carbonic inhibitors important infor
avoid with sulfa allergy and watch for electrolyte imbalances
signs/symptoms of retinal detachment
Sudden floaters, flashes, blurred vision, reduced peripheral vision, curtain-like shadow over field of view
type of conjunctivitis associated with a history of URI
viral (adenovirus, H. simplex)
very contagious!!!
how to instill eye drops or ointment for conjunctivitis
Apply drops to inner canthus
What side effects can occur with someone who is having cerumen impaction irrigation?
Vertigo/dizziness
Perforation of tympanic membrane
what condition can cause tympanic membrane perforation
acute and chronic otitis media
Meniere’s disease has what 3 symptoms
vertigo, tinnitus, hearing loss
medical treatment for Meniere’s
Antihistamines (Antivert)
Tranquilizers (valium)
Antiemetics (Phenergan)
Diuretics
Shunting of the fluid or vestibular nerve suctioning (surgical)
nonmedical treatments for Meniere’s disease
Low salt diet (1000-1500 mg daily)
Increase water intake
Avoid caffeine
Limit alcohol intake
Avoid aspirin and MSG
Describe a patient who is at high risk for CVA. Age/race/medical conditions
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
what focused assessments should be performed on a pt who presents with possible CVA
Gag reflex
Respiratory pattern
Blood pressure
Carotid exam
Gross neurological deficits (cranial nerves)
Mental status (sensorium)
NNHS score
what imaging study is necessary to diagnose CVA to differentiate between hemorrhagic and ischemic
CT scan – view tissue
beneficial diagnostic studies in identifying cause of CVA
MRI – view vessels
carotid ultrasound – carotid bruit/blockage
EKG – AFIB
emergent treatment of ischemic stroke
tPA
goal of tPA
dissolve clot; restore blood flow to brain regions affected by a stroke
what info is needed prior to administering tPA
time of onset of stroke symptoms
How often should the patient be reassessed with tPA
every 15 minutes for the first 2 hours
complication of tPA
worsening bleeding in the brain
patients who CANNOT have tPA
- 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
what should the nurse do if the patient could not have tPA and has ICP
mannitol
Describe non-emergent medical and management treatment for those who had CVA
Treat the underlying cause of the stroke – HTN, HLP, AFIB, and alcohol/tobacco use
Use anticoagulants and platelet inhibitors for drug tx
nursing considerations of post op carotid endarterectomy
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
ischemic stroke symptoms
confusion
AMS
loss of balance, coordination, dizziness
perception disturbances
emotional lability/depression
inappropriate emotional response (PBA
hemorrhagic stroke symptoms
sudden HA
N/V
sudden LOC
seizures
nuchal rigidity
hemiparesis
symptoms of both ischemic and hemorrhagic strokes
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
4 complications of a hemorrhagic stroke
rebleed
hematoma
hydrocephalus (ICP)
hypoxia
nursing interventions rebleed
watch for bleed
avoid anticoagulants
nursing interventions hematoma
avoid anticoagulants
nursing interventions hydrocephalus
CSF drainage
ventricular shunt
mannitol
HOB at 30 degrees
avoid hypo/hyperglycemia
nursing interventions hypoxia
proper oxygenation/ventilation
how to prevent vasospasm after hemorrhagic stroke
control BP with calcium channel blocker or triple h therapy
CCB used for vasospasm prevention
Nimodipine (nymalize)
what is triple H therapy and why is it used
hypervolemia (fluid volume expanders), induced hypertension, + hemodilution
used to avoid hypotension (and hypertension)
