TEST 2 MOD 8 WINKS Flashcards
describe visual deficits for cataracts
opacity of LENS which blocks light going into eye
When you’re young, the lens in your eye is clear. Around age 40, the proteins in the lens of your eye start to break down and clump together. This clump makes a cloudy area on your lens — known as a cataract
everything is generally blurry and grayish/brown
describe visual deficits for GLAUCOMA
structural eye disorder that causes an increase in intraocular pressure, can lead to blindness.
caused by damage to the optic nerve, which leads to visual field loss. One of the major risk factors is eye pressure. An abnormality in the eye’s drainage system can cause fluid to build up, leading to excessive pressure that causes damage to the optic nerve. The damage to your eyes starts when sugar blocks the tiny blood vessels that go to your retina, causing them to leak fluid or bleed. To make up for these blocked blood vessels, your eyes then grow new blood vessels that don’t work well.
blackness all around vision
describe visual deficits for MACULAR DEGENERATION
loss of central vision from deterioration of center of the retina
It happens when aging causes damage to the macula — the part of the eye that controls sharp, straight-ahead vision. The macula is part of the retina (the light-sensitive tissue at the back of the eye).
Big gray spot in the middle of your vision
associated nursing care FOR MACULAR DEGENERATION
Monitor visual acuity, internal and external eye structure with a optholmoscope, and pt’s functional ability.
associated nursing care FOR GLAUCOMA
Call out your name before approaching so you don’t startle them.
stay w/ in client field of vision if they have partial loss
explain interventions before touching the client
inform client youre leaving before departure
orient pt to area
describe arrangement of food on the tray before leaving the room
associated nursing care FOR CATARACTS
Monitor visual acuity, internal and external eye structure with a optholmoscope, and pt’s functional ability.
Perioperative care for cataract surgery
No solid food for 6 hours prior to your surgery.
No thick liquids after midnight (Milk, cream, orange juice, prune juice.)
Up to 2 hours before surgery, we encourage you to drink clear liquids (coffee, tea, apple juice, water, soft drinks or meat broth.) Sugar in your coffee and tea is okay, but no milk products.
You Must Take usual morning medications, EXCEPT FOR INSULING AND OTHER DIABETIC MEDICATION prior to arrival at the surgery center. (Heart, High Blood Pressure, Chronic Pain, Seizure, or Tremors) Take with a sip of water only.
Put your pre-op eye drops your surgery eye.
Completely and thoroughly remove all face makeup.
Please remove all of your jewelry and leave it at home.
Wear comfortable clothing. Please wear shirts or blouses that button or zip up the front. Long sleeves are okay as long as the fabric is lightweight.
The nurse will provide you with a cap to wear over your hair and a gown to be worn over your clothing. You will be assisted to a comfortable reclining chair where you will rest. An anesthetic eye drop will be administered followed by dilating gel. Your general health is monitored, and an anesthesiologist will start your IV and administer appropriate sedation. Sedation and topical or local anesthesia will be given to ensure your comfort before, during and after surgery
Primary and secondary prevention for hearing loss
Primary prevention is aimed at reducing the possible sources of hearing impairment. Secondary prevention involves screening for hearing loss, if possible before any symptoms appear
how to communicate with people who have hearing loss
GET CLIENTS ATTENTION BEFORE SPEAKING
TRY DEEPENING VOICE BEFORE YELLING
TALK IN QUIET, WELL-LIT ROOM
SPEAK CLEARLY AND SLOWLY WITHOUT COVERING VIEW OF MOUTH
ARRANGE FOR COMMUNICATION SUPPLEMENTATION
Parkinson’s assessment findings (TRAP)
Tremor at rest *Often 1st sign
Rigidity
Increased resistance to passive motion when the limbs are moved through their range of motion (ROM)
Akinesia
Absence or loss of control of voluntary muscle movements
Postural instability
Unable to stop from going forward or backward
Unusual clumps of protein calledLewy bodiesare found in the brains of patients with PD.
nursing care to prevent complications for Parkinson’s patients
Motor symptoms
Dysphagia (difficulty swallowing)
Weakness
Dementia
Depression, hallucinations, and psychosis
home care for Parkinson’s patients
PT to maintain muscle tone and OT for ADLs
Encourage environmental changes to improve safety. These include removing rugs and excess furniture to avoid stumbling, using an elevated toilet seat to help the patient get on and off the toilet, and elevating the legs of an ottoman to decrease dependent ankle edema.
What is Levodopa
Levodopa is the precursor of dopamine. It is converted to dopamine in the brain.
Do not give levodopa with food because protein reduces absorption.
effects may be delayed for several weeks to months
Take 30-60 minutes before meals for quicker absorption
What is Carbidopa
Carbidopa inhibits an enzyme that breaks down levodopa before it reaches the brain.
What med combines carbidopa and levodopa
(Sinemet)
Side effects include:
Uncontrolled movements
Mental status changes
Severe n/v
Difficulty urinating
side effects of levodopa
Prolonged use often results in dyskinesias (uncontrollable movement) and “off/on” periods when the medication will unpredictably stop or start working.
Monitor for short-term adverse effects of nausea, vomiting, and light-headedness.
What are 2 DA Receptor Agonists used for Parkinsons
Pramipexole (Mirapex)
Ropinirole (Requip)
may be used alone or in combination with Sinemet. Many of these medications are available in extended-release forms that improve patients’ ability to adhere to treatment plans.
Side effects of Pramipexole (Mirapex)
- Take the drug with food to decrease nausea.
- Notify the HCP immediately if uncontrollable urges, confusion, muscle rigidity, excess urination, shortness of breath, or vision changes occur.
Why use an anticholinergic drug with a dopamine drug for Parkinson treatment?
anticholinergics are usually reserved for the treatment of tremor that is not adequately controlled with dopaminergic medications.
which drugs do you use for an acute seizure that does not spontaneously resolve
The names of benzodiazepines that are most commonly used as rescue medications include: diazepam (Valium®), lorazepam (Ativan®), and midazolam (Versed®)
which drugs do you use for status epilepticus
Requires rapid-acting IV medications
Benzodiazepines such lorazepam (Ativan) or diazepam (Valium)
Followed by a long-acting drug such as phenytoin or phenobarbital (a barbiturate)
which drugs need to have blood levels monitored
Carbamazepine.
Clozapine.
Levetiracetam.
Phenobarbital.
Phenytoin.
Valproic acid.
common CNS side effects for seizure medications
Diplopia, drowsiness, ataxia, mental slowness
nursing implications for patients with seizures
Antiseizure drugs should not be discontinued abruptly
Medication nonadherence can be a problem in people with seizure disorder, often due to undesirable side effects.
Ataxia is a neurological sign consisting of lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, and abnormalities in eye movements. Ataxia is a clinical manifestation indicating dysfunction of parts of the nervous system that coordinate movement, such as the cerebellum.
Nursing care during and after a seizure
Pad bed rails
Bed in low position
Assist patient with ambulation or provide standby
Do not leave alone in the bathroom
Have suction and oxygen readily available
Observe and document details, including timing
Monitor/maintain airway patency
Protect the patient’s head, turn the patient to the side (LATERAL RECUMBANT POSITION), loosen constrictive clothing, ease patient to floor if seated
Do not restrain or place item in the patient’s mouth
Most seizures resolve spontaneously (i.e.: epilepsy at home)
Document:
What events preceded the seizure?
When did the seizure occur?
How long did each phase (aural [if any], ictal, postictal) last?
What occurred during each phase?
Assessment of the postictal period should include a detailed description of the level of consciousness, vital signs, pupil size and position of the eyes, memory loss, muscle soreness, speech disorders (aphasia, dysarthria), weakness or paralysis, sleep period, and the duration of each sign or symptom.
patient teaching for patients with seizures
Antiseizure drugs should not be discontinued abruptly
Many drugs require monitoring of serum drug levels
Side effects
CNS-related: Diplopia, drowsiness, ataxia, mental slowness
Ketogenic diet
A special high-fat, low carbohydrate diet helps to control seizures in some people
Protein is also restricted
Family members/significant others should be taught emergency management
Ambulance (9-1-1) does not need to be called unless the seizure prolonged, the patient has a second seizure, if there are injuries, or if it was a first-time seizure.
Wear helmet if risk for head injury
General health habits
Assist to identify and instruct to avoid events or situations precipitating seizures
Instruct to avoid excessive alcohol, fatigue, and loss of sleep.
Generalized seizures affect what parts of the brain
both hemispheres of brain
Focal-Onset Seizure affect what side of the brain
Limited to 1 hemisphere
of brain
T/F: A patient who had a seizure during a marathon was rehydrated with IV fluids and taken to the hospital. This patient has a seizure disorder.
F. Seizures from systemic and metabolic problems are not considered seizure disorder if they stop when the underlying problem is corrected
What are the four phases of seizures?
Prodromal
Sensations or behavior changes that precede a seizure by hours or days
Aural
Warning an impending seizure
May include visual disturbances or unusual odors. Not all patients have it.
Ictal
During the seizure
Postictal
After the seizure. Return to baseline neuro status may take a few hours
difference between motor and nonmotor seizures
Motor seizures are described as either tonic-clonic or epileptic spasms. Non-motor seizures usually include a behavior arrest. This means that movement stops – the person may just stare and not make any other movements.
Name the four Nonmotor (Absence) seizures
- Typical
- Atypical
- Myoclonic (also motor)
- Eyelid myoclonia
The names of Motor Seizures generally include the words
- Tonic
- Clonic
Atonic
Describe a tonic-clonic seizure (generalized)
Characterized by loss of consciousness, falling to ground if upright, followed by stiffening of the body (tonic phase, lasts 10-20 sec.), then jerking (clonic phase, lasts 30-40 sec.)
Describe a atypical absence seizure (generalized)
Characterized by a staring spell.
May also have eye blinking or jerking lip movements
May be somewhat responsive
Usually, last 10-30 seconds
Starts in childhood and usually continues into adulthood
Difference between simple and complex FOCAL seizures
Simple Sx depending on where in brain. starts in 1 hemisphere may go to other to become tonic-clonic. Person is conscious and alert but experience unusual feelings (i.e. anger, joy, sadness) or sensations (i.e. hear, taste, see, or feel things that aren’t real)
Complex characterized by a loss of consciousness or alteration in awareness (dreamlike state)
Eyes open, may make purposeful movements, but unable to interact with others.
May have lip smacking or other repetitive motions.
May exhibit dangerous or embarrassing behaviors.
Lasts 30 sec. to 2 minutes
Most useful diagnostic tool for seizures
accurate, comprehensive description of seizures and the patient’s health history
major mechanisms of action of Drug therapy aimed at preventing seizures
Decrease the rate at which sodium enters the cell
Inhibit calcium flow into cell
Increase the effect of the inhibitory neurotransmitter gamma-aminobutyric acid (GABA)
Block Glutamate, an excitatory neurotransmitter
Primary drugs for treatment of generalized tonic-clonic and focal seizures
phenytoin (Dilantin)
carbamazepine (Tegretol)
phenobarbital
divalproex (Depakote)
primidone (Mysoline)
primary side effect of phenytoin (Dilantin)
What treatment does status epilepticus seizures require that others don’t
Requires rapid-acting IV medications
Benzodiazepines such lorazepam (Ativan) or diazepam (Valium)
Followed by a long-acting drug such as phenytoin or phenobarbital (a barbiturate)
Define status epilepticus seizures
A seizure that lasts longer than 5 minutes, or having more than 1 seizure within a 5 minutes period, without returning to a normal level of consciousness between episodes is called status epilepticus. This is a medical emergency that may lead to permanent brain damage or death.
Nursing care in acute phase of stroke
Elevate head of bed 30 degrees if no symptoms of shock or injury occur
Institute seizure precautions
Establish communication
Hypertension is common
Pulmonary hygiene (prevent atelectasis)
Early mobility
Interventions to prevent VTE
Decrease risk of skin breakdown
Address self-care deficits
Patient is assessed for both the ability to speak and the ability to understand.
Speak slowly and calmly, using simple words or sentences.
Gestures may be used to support verbal cues.
Use of clipboards/whiteboards
Explain
What has happened
Diagnosis
Treatments
Range-of-motion (ROM) exercises and positioning are important.
Paralyzed or weak side needs special attention when positioned.
Position patient on the weak or paralyzed side for only 30 minutes.
aLWAYS PAD AFFECTED SIDE.
Assisting with eating
Test swallowing, chewing, and pocketing before beginning oral feeding
Provide oral care before and after feeding
Position upright
Suction should be available
Sensory-perceptual alterations
Blindness in same half of each visual field is a common problem after stroke.
Known as homonymous hemianopsia. Homonymous hemianopsia(blindness in the same half of each visual field) is common after a stroke. Persistent disregard of objects in part of the visual field should alert you to this possibility.
At first, help the patient to compensate by arranging the environment within the patient’s perceptual field, such as arranging the food tray so that all foods are on the right side or the left side to accommodate for field of vision.
Later, the patient learns to compensate for the visual defect by consciously attending to or by scanning the neglected side. Weakor paralyzed extremities are carefully checked for adequacy of dressing, hygiene, and trauma.
May also have double vision
Nursing care in rehabilitation phase of stroke
May be discharged to home, an intermediate or long-term care facility, or a rehabilitation facility.
Loss of postural stability is common after stroke.
When the nondominant hemisphere is involved, walking apraxia and loss of postural control are usually apparent.
The patient is unable to sit upright and tends to fall sideways.
Appropriate support with pillows or cushions should be provided.
Apraxia is a motor disorder caused by damage to the brain which causes difficulty with motor planning to perform tasks or movements. The nature of the damage determines the disorder’s severity, and the absence of sensory loss or paralysis helps to explain the level of difficulty.
Communicating With a Patient With Aphasia
The following are guidelines for communicating with a patient with aphasia:
1. Decrease environmental stimuli that may be distracting and disrupting to communication efforts.
2. Treat the patient as an adult.
3. Speak with normal volume and tone.
4. Present a single thought or idea at a time.
5. Keep questions simple or ask questions that can be answered with “yes” or “no.”
6. Let the person speak. Do not interrupt. Allow time for the person to complete thoughts.
7. Make use of gestures as an alternative form of communication. Encourage this by saying, “Show me . . . .” or “Point to what you want.”
8. Do not pretend to understand the person if you do not. Calmly say you do not understand. Encourage the use of nonverbal communication or ask the person to write out what they want.
9. Give the patient time to process information and generate a response before repeating a question or statement.
10. Allow body contact (e.g., clasp of a hand, touching) as much as possible. Realize that touching may be the only way the patient can express feelings.
11. Organize the patient’s day by preparing and following a schedule (the more familiar the routine, the easier it will be).
12. Do not push communication if the person is tired or upset. Aphasia worsens with fatigue and anxiety.
13. Teach communication techniques to caregiver and family members.
stroke Risk factors
Non-modifiable:
Age
Gender
Race
Heredity/family history
Modifiable:
Hypertension
Metabolic syndrome (HTN, Obesity, high cholesterol, hyperglycemia)
Heart disease
Heavy alcohol consumption
Poor diet
Drug abuse
Sleep apnea
Obesity
Physical inactivity
Smoking
Hypertension is the single most important modifiable risk factor. The proper treatment of hypertension reduces stroke risk up to 50%
It is thought that modifiable risk factors cause 90% of strokes
Pathology of hemorrhagic stroke
Intracerebral or intraparenchymal hemorrhage
Bleeding into the brain tissue itself
Subarachnoid hemorrhage (SAH)
Bleeding into the subarachnoid space
Intraventricular hemorrhage
Bleeding into the ventricles
stroke prevention
Health promotion focuses on (1) healthy diet, (2) weight control, (3) regular exercise, (4) no smoking, (5) limiting alcohol consumption, (6) BP management, and (7) routine health assessments.
Stroke Prevention
* Reduce salt and sodium intake.
* Maintain a normal body weight.
* Follow a diet low in saturated fat and high in fruits and vegetables.
* Limit alcohol use to moderate levels.
* Maintain an SBP less than 140 mm Hg.
* Exercise 40 minutes 3 to 4 days per week.
* Avoid cigarette smoking and tobacco products.
* Maintain a normal blood glucose level and control diabetes.
* Follow the prescribed treatment plan for diagnosed cardiac problems.
Aspirin, at a dose of 81 mg/day, is the most often used antiplatelet agent. Other agents include ticlopidine, clopidogrel (Plavix), dipyridamole
(Persantine), and combined dipyridamole and aspirin (Aggrenox).
Statins (e.g., simvastatin, lovastatin) are effective in stroke prevention for those with high cholesterol levels who had a TIA.
stroke diagnostic testing
a blood test to find out your cholesterol and blood sugar level
checking your pulse for an irregular heartbeat
taking a blood pressure measurement
Even if the physical symptoms of a stroke are obvious, brain scans should also be done to determine:
if the stroke has been caused by a blocked artery (ischaemic stroke) or burst blood vessel (haemorrhagic stroke)
which part of the brain has been affected
how severe the stroke is (CT/MRI)
Swallow test
echocardiography
carotid ultrasound
purpose, action, side effects of antiplatelet drugs
Aspirin, at a dose of 81 mg/day, is the most often used antiplatelet agent. Other agents include ticlopidine, clopidogrel (Plavix), dipyridamole
(Persantine), and combined dipyridamole and aspirin (Aggrenox).
indications for tPA (thrombolytic therapy)
BLOCKED ARTERTY DX W/ CT W/ NO HISTORY OF BLEED (TRAUMA, SURGERY, GI ISSUES)
Deficits after stroke (LEFT/RIGHT BRAIN)
LEFT BRAIN STROKE:
Slower in organization and performance of tasks
Impaired spatial discrimination
Fear, anxiety
Respond well to nonverbal cues
RIGHT BRAIN STROKE:
Difficulty in judging position, distance, and movement
Impulsive, impatient, and denying problems related to stroke
Respond best to directions given verbally
treatment for stroke patients
Recombinant tissue plasminogen activator (tPA) (The fibrinolytic action of tPA occurs as the plasminogen is converted to plasmin, whose enzymatic action then digests fibrin and fibrinogen, thus breaking down the clot.)
Recombinant tissue plasminogen activator (tPA)
Reperfusion Therapy
Aspirin may be used within 24-48 hours of ischemic stroke.
Once patient is stabilized, anticoagulants or antiplatelet drugs may be used in an effort to prevent further clot formation
Statin drugs may also be used
Endovascular procedures to open blocked arteries
Anticoagulant and antiplatelet drugs are contraindicated
HTN management
Goal is normal/high (SBP < 160)
Seizure precautions may be instituted
Surgical procedures
Evacuation of hematomas > 3 cm
Interventional radiology
Clipping/coiling of aneurysms to protect against hemorrhage
Followed by oral Nimodipine to prevent cerebral vasospasm (assess BP and HR)
nursing care for stroke patients
Patients may have difficulty keeping an open and clear airway because of a decreased level of consciousness or decreased or absent gag and swallowing reflexes.
Maintaining adequate oxygenation is important. O2administration, artificial airway insertion, intubation, and mechanical ventilation may be needed.
Baseline neurologic assessment is carried out, and patients are monitored closely for signs of increasing neurologic deficit.
Many patients may worsen in the first 24 to 48 hours.
ABCs are the highest priority
Elevated BP is common immediately after a stroke. It may be a protective response to maintain cerebral perfusion. Drugs to lower BP are used only if BP is markedly increased (SBP greater than 220 mm Hg or DBP greater than 120 mm Hg).
Preventing complications after stroke
Elevate head of bed 30 degrees if no symptoms of shock or injury occur
Institute seizure precautions
Establish communication
Hypertension is common
Describe the pathology of a thrombotic stroke
Thrombosis develops readily where atherosclerotic plaques have already narrowed blood vessels.
Thrombotic stroke is the most common cause of stroke. It accounts for about 60% of strokes.
They are more common in older adults, especially those with high cholesterol, atherosclerosis, or diabetes.
Describe the pathology of a embolic stroke
blood clot (embolus) or other debris circulates in the blood until it reaches an artery in the brain that is too narrow to pass.
Most emboli originate in the endocardial (inside) layer of the heart, when a plaque breaks off from the endocardium and enters the circulation.
The embolus travels upward to the cerebral circulation and lodges where a vessel narrows or bifurcates (splits).
Heart conditions, including atrial fibrillation, MI, infective endocarditis, rheumatic heart disease, valvular heart prostheses, patent foramen ovale, and atrial septal defects, account for most embolic ischemic strokes.
Early recognition acronym
BEFAST
BALANCE
EYES
FACE
ARMS
SPEECH
TIME
