test 1; Eye/Ear/Neuro Flashcards
1
Q
The eye is the sensory organ of _______
A
vision
2
Q
What is the elliptical open space between the upper and lower lid?
A
Palpebral fissue
3
Q
What is the part of the eye that provides constant irrigation through tears?
A
Lacrimal apparatus
4
Q
How are tears drained?
A
Puncta
5
Q
When we see an object, the image is _______ on the retina
A
Upside down
6
Q
What is the area between the cornea and the lens?
A
Aqueous humor
7
Q
What is the gelatin like substance that is behind the eye ball that serves as a cusion?
A
Vitrous humor
8
Q
What is the normal IOP?
A
10-21
9
Q
What is the most frequent method to measure IOP?
A
Tono-pen tonometry
10
Q
Myopia is _______________
A
nearsightedness
11
Q
In myopia, the light rays are falling _________ the retina
A
in front of
12
Q
What are causes for Myopia
A
Excessive light refraction
Abnormally long eye
Lens swelling causes by hyperglycemia
Happens during growth spurts
13
Q
Hyperopia is ______________
A
farsightedness
14
Q
Hyperopia is caused when light rays are focusing _______ the retina
A
behind
15
Q
What are the causes of hyperopia?
A
Inadequate focusing power
Eyeball is too short
16
Q
________ is a form of hyperopia that is normal when you get older
A
Presbyopia
17
Q
What are some things to try if a patient has presbyopia?
A
Hold the objects farther away
Bifocals or Trifocals
18
Q
What is the irregular or unequal corneal curvature causing the parallel light rays to be bent unequally?
A
Astigmatism
19
Q
What is the difference between LASIK and PRK
A
In lasik, there is a flap of the cornea and PRK there is not!
20
Q
LASIK is better for severe _______
A
Myoptics and severe myopia
21
Q
PRK is the ______ of the cornea with laser
A
reshaping
22
Q
PRK is geared toward correcting what three disorders
A
myopia
hyperopia
Astigmatism
23
Q
A hordeolum is what?
A
An infection of the sebaceous gland in the lid margin and it is normally caused by S. Aureus
24
Q
What eye condition is characterized by a red, swollen, circumscribed and tender area on the eyelid (normally lower)
A
Hordeolum (sty)
25
What are the three treatment considerations for a sty
Warm compress
No makeup
Lid scrub (with baby shampoo)
IF IT PERSISTS FOR MORE THAN 72 HOURS MAY NEED ABX
26
What is the infection of the conjunctiva?
Conjunctivitis
27
What are the two kinds of conjunctivitis?
Bacterial and Viral
28
Bacterial conjunctivitis is highly __________
Highly contagious; needs ABX
29
What are two causes of bacterial pink eye?
Staph A. and Strep P.
30
What are s/sx of pink eye (conjunctivitis)
discomfort
Pruritus
Redness
Mucopurulent drainage
31
What surgery is removing layers of the cornea?
LASIK
****(Layers in Lasik)***
32
What eye surgery shaves and reshapes the cornea?
PRK
***Reshapes in PRK***
33
what surgical procedure can give you almost perfect vision in almost 24 hours?
LASIK
34
MonoVision therapy is uses in what surgery?
LASIK
35
PRK is used for a patient that has a very ____ cornea
THIN
36
What are the 4 treatment considerations for bacterial pink eye?
ABX drops
Strict hand washing
Careful handling of drainage
Warm compress
37
The signs and symptoms of viral pink eye are what?
***feels like something is in their eye***
Itching
Burning
Redness
Mild photophobia
38
pink eye may happen after what two events?
A URI
Swimming
39
Usually viral pink eye is ___-__________ but if it lasts longer than 3 days you may need ______ drops
steroid
40
What is the inflammation and infection of the cornea?
Bacterial Keratitis
41
Bacterial Keratitis is normally caused by
CONTACT LENSES
42
Treatment considerations for Bacterial Keratitis?
Topical ABX
(MAY NEED 2; PO, sub-conjunctival or IV ABX)
43
What is the viral infection of the cornea?
Viral Keratitis
44
What are the two most common forms of viral Keratitis?
Herpes SImplex Virus
Herpes Zoster Opthalmicus
45
For HSV Keratitis, you would use what medication
Antiviral Eye drops (CORTICOSTEROIDS ARE CONTRAINDICATED)
46
HSV Keratitis can lead to corneal ________
blindness
47
VSV Keratitis, there is a ______ break-out in the mucous tissue areas like the eye tissue
Virulent
48
What is the treatment considerations for VSV Keratitis?
Analgesics
topical corticosteroids
Antiviral
Mydriatic agents
Topical ABX- Secondary infections
49
What is the opacitiy within the lens which presents with a glare?
Cataracts
50
Treatment for cataracts?
Surgery
51
After cataract surgery what things do you want to consider?
Decrease IOP
Infection prevention
Pain control
52
What are the signs and symptoms of a retinal detaching (the process of it actually detaching)? ***FFR***
Flashes
Floaters
Ring in the field of vision
53
Once the retina is detaches what are the s/sx?
Painless loss of vision in the area of detachment
54
Macular degeneration is the degeneration in the macula that results in what?
central vision loss
55
What is the difference between dry and wet MD
Dry MD- slow progression and painless vision loss
Wet Md- this is a more severe rapid vision loss with abnormal blood vessels forming around the macula
56
What is a condition that is characterized by increased IOP which can result in optic nerve atrophy and peripheral visual loss?
Glaucoma
57
What are the meds given for POAG treatment?
Beta adrenergic blockers- decreases aqueous humor production
Alpha adrenergic blockers- decrease aqueous humor production and increase outflow
Mitotic- constrict the iris to increase outflow
58
What is the inflammation or infection of the epithelium of the auticle of the ear canal
external otitis
(Swimmers ear)
59
What are the s/sx of external otitis?
Ear pain is first symptom
Swelling of the ear canal
Muffled hearing
Discharge
Fever occurs with infection
60
Treatment for Swimmers Ear?
ABX drops for Infection
Corticosteroid drops for Inflammation
Good hygiene when giving ear drops
Keep ear dry (May use OTC drying drops)
Warm moist external compresses
61
What is the inflammation of the middle ossicles and space in the middle of the ear?
Otitis Media
62
What are the symptoms of Otitis Media?
History of nasal congestion (allergies)
Muffled hearing
Pain in ear and /or down neck
Sore throat
Fever
63
What is the presentation of otitis media?
Redness, swelling & bulging of tympanic membrane
Fluid and or pus trapped under eardrum
64
Treatment for Otitis Media?
PO ABX for 10 days (may need 2nd ABX)
Monitor meds for ototoxicity
Antihistamines if allergies are root cause
Adult myringotomy
65
what is the autosomal dominant disease where the
footplate of the stapes is immobilized from spongy
one being developed
Otosclerosis
66
What is used for Otosclerosis?
Rinne test
67
What is the education for a patient with otosclerosis?
After surgery they will hear good, and then it will decrease with the swelling but then will get better again, but education about this so they do not get freaked out
68
What is the Unknown etiology, abnormal accumulation of endolymph/fluid in the inner ear. Usually between ages 30-60…
Meniere's Disease
69
Presentation of Meniere's Disease?
Sudden attacks of Vertigo
Nausea & Vomiting
Sweating & Pallor
Tinnitus
Fluctuating sensorineural hearing loss
Aural fullness
70
Treatment considerations for Meniere's Disease
Ongoing (ambulatory) Care- because they are dizzy
Diuretics, sedatives, antihistamines, calcium channel blockers
Avoid nicotine, caffeine, ETOH, foods with MSG and do not go on a low sodium diet
Avoid flickering lights & television during attacks
71
What are some reasons for conduction hearing loss?
Impacted cerumen
Foreign body
Perf. of tympanic membrane
Otitis media with effusion
Otosclerosis
72
What is the hearing loss that is due to impairment of CN 8
Sensorineural
73
Steps for easing into hearing aids
First – restrict to quit areas of home
Second – expand use to outdoors
Finally – incorporate into other environments based on the individuals desire and need
74
What is the part of the brain that is in charge of production of speech?
Broca's Area
75
What is the inability to ***express***
written of spoken language?
Broca's aphasia
76
Broca's area is in which area of the brain?
Frontal Lobe
77
Werkicke's area is in the _______ lobe?
Temporal
78
Wernickes area is in charge of what?
understanding language
79
What is the inability to understand written or spoken language?
Wenickes Aphasia
80
If you have both brocas and wernickes aphasia it is called?
Global aphasia
81
What lobe is in charge of judgement, motor function ,memory, concentraction and personality?
Frontal
82
What is a uncontrolled electrical impulse in the brain?
Seizure
83
A seizure is a _______; Epilepsy is a ______
Sympton; Disorder
84
Tonic/Clonic seizure of a Grand Mal is a full seizure that looks like what?
Stiffening and jerking phase
85
A patient is consciois and alert but may have unusual sensations, this is like what kind of seizure?
Focal/Partial
86
What are staring spells that are actually seizures noticed in kids?
Absent seizures
87
What is a constant seizure for more than 5 minutes and or back to back seizures without a return of consciousness?
Status Epilepticus; NEURO EMERGENCY
88
What is the immediate treatment for status epilepticus?
IV BENZO
89
Nursing care for seizures?
Ensure safety
Document all the details
TIME CAREFULLY and if it is longer than 5 minutes it is a code blue
90
What are some other seizure considerations?
No suction in mouth
Pad the bed
Do not hold them down
91
What is an autoimmune desctruction of the myelin sheath?
Multiple Sclerosis (MS)
92
In the late stage of MS, ______ degenrate so there are no nerve impulses?
Axons
93
What is the clear pattern of relapsing and remitting in MS?
Relapsing and remitting
94
What is the stage in MS where there is a progressive decline with a temp. improvement?
Primary Progressive
95
What stage of MS is characterized like relapsing remitting but keeps getting worse?
Secondary Progressive
96
What is a common sign for MS?
L'hermittes sign; they flex the neck and there is a shocking sensation down the spine
97
Nursing care for MS
Promote independence
Journal to figure out triggers
Maintain nutrition
Manage complication with mobility
98
What is a decrease in dopamine in the substantia region of the brain?
Parkinsons Disease (PD)
99
TRAP of PD?
Tremon
rigidity
Akinesia
Bradykinea
100
Treatment for PD?
Levodopa/Carbidopa
101
What is the nursing care for PD?
Promote optimal function
Self Care
Independence
Aspiration risk
Maintain diet and weight
Falls Risk
Drooling (give 1% atropine)
102
Early signs of PD?
slight limp, tremor, etc.
103
What is an autoimmune disease at the neuromuscular junction that leads to weakness of the skeletal muscles; low ACH receptors?
Myasthenia Gravis (MG)
104
________ of MG patients have anti ACH receptor antibodies
85-90%
105
What is the main s/sx of MG
muscle fatigue that gets better with test
106
COmplication of MG?
Resp. insufficiency, infection
Aspiration
107
3 tests for MG
Tensillion Test
Eye droop test
108
Drugs that can be used to treat MG?
Anticholinesterase Drugs
Corticosteroids
Immunosuppressants- body is attacking itself; calms the immune system down
Plasmapheresis and removal of thymus can also be done
109
Nursing care for MG?
Perform tasks in the AM; this is when they have the most energy
Monitor eating- choking risk
Allow for alternate communication (it can be hard to speak)
Do not encourage hot showers
110
What is the most common form of dementia that is multifactorial with both genetics and environmental risk factors?
Alzheimer's Disease (AD)
111
What are some characteristics of AD?
Many beta amyloid plaques
Neurofibrillary tangles
(seen at autopsy)
112
Nursing care of AD?
Risk of injury and wandering
Coping for the patient
Family burnout?
Self esteem issues
113
What are treatment options for AD?
Cholinesterase Inhibitors
SSRIs
Antipsychotics
Sleeping Aids
114
You cannot stop ___ but you can slow it down
AD
115
KNOW THE GLASGLOW COMA SCALE
!!!
116
Eye opening response in glasgow coma scale
4- opens spontaneously
3- opens to command
2-open to pain
1- none
117
Verbal response in glasglow coma scale
5- orientated and answers well
4-confused but able to answer
3- Odd words
2- Incoherent Sounds
1- None
118
What is the hydrostatic force measured in the brain compartment?
ICP
119
Normal ICP is?
5-15
120
ICP of over 20 means
Needs treatmetn
121
ICP of over 30 or 40
Brainstem herniation
122
ACIDOSIS LEADS TO what?
cerebral vasodilation and increased ICP- fix the acidosis
123
What is the first sign of increased ICP?
change in LOC
124
What are other signs of ICP
Projectile vomiting
Cushing's Triad- bradycardia with bounding pulse, irregular RR and widening PP (normal is 40-60)
Fixed unilateral dilated pupil (shows brainstem herniation)
125
Nursing care for increased ICP
HOB at 30 degrees
Maintain O2
Avoid things that increase ICP- sneezing coughing etc.
Cluster care to minimize stimulation
Have a dark environment
Do not suction
Check ABG to check for acidosis
126
What is the top pritority for neuro?
perfusion
127
How do you calculate CPP?
MAP-ICP = CPP
128
What is the normal CCP?
60-100 mmHg
129
What is the big concern for a scalp laceration?
Risk for infection
130
Signs of a skull fracture
Battle sign- bruising by ear
Racoon Eyes- exactly what is sounds likes
Basal skull fracture- ***DO NOT PLACE A NG TUBE BLINDLY***
CSF leak? (from nose or ear)
131
If you suspect a CSF leak what would show you that it is CSF?
Halos sign (will see a yellow ring or halo)
132
If you use a glucometer to check CSF, the glucose level will be
40-70
133
What is a sudden change in LOC w/ or w/o loss of consciousness
Concussion
134
What can happen 2 weeks-months after an injury (concussion)
Post concussion syndrome
135
S/Sx of Post Concussion Syndrome?
HA, lethargy, change in personality behavior, attention span etc.
136
What is the bruising of the brian due to closed head injury?
Contusion
137
Ipsilateral Pupillary changes show
Contusions
138
What med can change outcomes of head traumas?
ANTICOAGS.
It changes the bleeding and can lead to much worse outcomes
139
What is the bleeding between the dura matter and the inner surface of the skull?
Epidural Hematoma
Arterial in nature
140
What is the hallmark sign of an epidural hematoma?
They hit their head, pass out, wake up, and pass out agian
141
What is the bleeding the dura mater and the arachnoid layer?
Subdural hemaotma
142
A subdural hematoma is ______ in nature and occurs a few hours or days after the trauma
VENOUS
***Wrote a patho about a man who fell and hit his head, days later he had a subdural hematoma!***
143
What is the gold standard for D/x in head trauma?
Head CT
144
Nursing care for head trauma
Pain-
Fever- due to trauma in the hypothalamus not infection
Neuro checks
Manage ICP
145
What is the consideration for brain tumors
Operability is perhaps more important on whether it is malignant or benign. (If it is benign, but is an inoperable place it can be more deadly than a cancerous one in a "good" place)
146
What is a stroke that happens because a clot forms from a vessle wall injury?
Thrombotic Ischemic Stroke
147
What is the biggest factor for an ischemic stroke?
HTN
148
T/x for Ischemic Stroke?
ASA
TPA
Cerebral angiography
149
What is bleeding within the brain?
Intracerebral hemorrhage (stroke)
150
What kind of stroke that is bleeding into the subarachnoid space and they say it is the ***worst headache of their life***?
Subarachnoid hemorrhage
151
For a subarachnoid hemorrhage they will then go to neuro ICU for 14 days bc we are worried about
Cerebral vasospasm
152
In the neuro world, they allow for _____________ ____ because it allows for better blood flow
Permissive HTN (for 24-72 hours)
153
Treatment for Subarachnoid hemorrhage?
Surgery
ICU
HHH therapy
Calcium blocker therapy
154
What are the clinical manifestations of stroke?
Facial Droop
Arm
Speech changes
Terrible HA
Can also have damage for Broca's area, Wernicke's area, or global aphasia
155
What is the first thing you do before even thinking about treatment of a stroke
Get a head CT, because it changes the treatment
156
Review when you can or cannot give tPA
must be administers within 3-4.5 hours of symptom onset
Do not give if they have had a hemorrhagic stroke, coagulation disorders GI bleed, head trauma, or major surgery within the last two weeks
157
What is the acute inflammation of the lining of the brain?
Meningitis
158
Hallmark sign of meningitis?
Nuchal Rigidity
159
What are two other signs for meningitis
Kernig's sign
Brudzinski's sign
160
If a patient has cloudy CSF after a Lumbar puncture you would suspect what kind of meningitis?
Bacterial (BAD)
161
If a patient has clear CSF after a lumbar puncture you would suspect what kind of meningitis?
Viral (Better outcomes)
162
Trigeminal Neuralgia affects what CN?
5
163
S/Sx of Trigeminal Neuralgia?
Sudden pain
Twitching and tic like movements
164
What meds can be used for Trigeminal Neuralgia?
Carbamazepine
165
Bells Palsy resembles a stroke but is not a stroke and it affects CN ____
7
166
The clinical manifestations for Bells Palsy are very similar to stoke but also show
Inability to close one eye
Unilateral loss of taste
decreased ability to chew- aspiration!!
167
Nursing Management for Bells Palsy
Gentle massage
moist heat
Patch the eye if they cannot close it
Self Esteem
168
What is the rare neurological illness noted by ascending symmetrical paralysis?
Guillian Barre
169
GB normally happens after what?
URI or GI infection
After vaccination
170
Basically, GB affects all muscles and nerves so it is important to pay attention to
ALL THINGS BREATHING! It affects diaphragm
171
If a patient had a spinal cord injury to C3 (cervical injury) they will have
Tetraplegia and on a vent for life
172
If a patient had a spinal cord injury to the thoracic or lumbar spine (above T6), they will likely be a
Paraplegic
173
What is caused by damage to half of the spinal cord and there is a loss of motor function on the side of the injury(ipsilateral) and a loss of pain and temp. on the other side (contralateral)
Brown-Sequard Syndrome
174
What are clinical manifestations for Brown Sequard?
Resp- need mechanical ventilation
Hypotension and low BP
Need a cath
175
Nursing Care for Spinal Injuries
Pain
Prevent UTIS and Pneumonia
ROM
Watch for infection
Monitor cardiac status and nutrition
Need OT and PT
Support the patient and the family.
176
When you have a patient that has a HA and high BP they may have
Autonomic Dysreflexia
177
What are the locations used for a lumbar puncture
L3-L4
L5-L6
178
What is the glaucoma that is characterized by the outflow of aqueous humor is decreased in the trabecular meshwork the drainage becomes clogged this results in increased IOP... GRADUALONSET
Primary Open Angle Glaucoma (Gradual)
179
What is the glaucoma that is characterized by the angle between the iris and the cornea closes (happens rapidly)
Acute Angle Closure Glaucoma (Opthalamic Emergency)
180
What are the signs and symptoms of Acute angle closure glaucoma?
Sudden Pain
N/V
Blurred vision
Ocular Redness
Colored halos around lights
181
Motor response for Glasgow coma scale
6- Obeys commands
5- Moves to localized pain
4- Withdraws from pain
3- Abnormal Flexion
2- Abnormal Extension
1- None
182
What part of the brain is in charge of perception of space, and can cause safety issues if it is impaired
Parietal
***parietal think proprioception***
183
What lobe of the brain is in charge of perception and memory
Occipital
184
What part of the brain is in charge of memory, sound, understanding and language
Temporal
185
What is the stage of of MS that starts like relapse/remitting and then declines?
Secondary Progressive
186
What is the stage of MS that declines from the start with acute relapses that may or may not have remission?
Progressive Relapsing
187
What are some common MS triggers
Stress
Infection
Cold
188
Pharmacological considerations for MS?
Immunosuppression
Immunomodulator
Monoclonal antibodies
Muscle relaxants
189
Late signs of Parkinson's Disease?
Pill rolling that gets worse with stress and concentration. This is worse at rest, rigidity, and bradykinesia
