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NUR 120 > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

What are 6 age related changes to the eye? Explain.

A

Visual acuity-(snellen) lens, presbyopia (reading glasses)
Ocular structures-dec elasticity, en/entropion, lacrimal (dry eye)
Ocular fundus-mac degen
Cataract-lens
Glaucoma-dec IOP
Mac degenerate-drusen, central vision loss

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2
Q

What are 4 diagnostic studies related to problems of the eye?

A

Ophthalmoscopy-inner eye (direct, indirect)
Tonometry-IOP (screen for glaucoma)
Slit lamp-magnification inner eye
Refraction/accommodation-eye shape and lens focus

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3
Q

What are 5 common eye disorder categories that occur across the lifespan?

A 
Disorders of cornea
Disorders of lens
Disorders of aqueous humor circulation
Disorders of posterior chamber
Ocular emergencies
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4
Q

More specifically, define disorder of the cornea.

A

Corneal Abrasions:
Commonly scratching, overuse of contacts, and foreign bodies.

Symptoms: pain, tearing, photophobia.

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5
Q

More specifically, define disorder of the lens.

A

Cataracts:
Nuclear-genetic, assoc. w/ myopia (nearsightedness)
Cortical-(lens)vision worse in light (sunlight exposure)
Posterior subscapsular- (front of post. Capsule) assoc. w/ Diab, trauma, light sensa, diminish near sight
Post OP- no Asa, lifting, use meds/patch/sunglasses.
Risks pg 1858

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6
Q

What are conservative and invasive tx’s for cataract?

A 
Medical:
Change glasses
Antioxidants
Magnify glasses
Mydiatics (pupil dilator): atropine, scopalamine
Surgical:
INTRA/extra capsular cataract extraction
Phagoemulsification
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7
Q

More specifically, define disorders of aqueous humor circulation.

A

Glaucoma: Tx same for both:
Open-most common, trabecular obstruction, asymptomatic, bilateral.
Closed-pupillary block, rapid progression, iris shift forward

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8
Q

What are the pharm tx for glaucoma?

A

Miotics(Coliner, eye constric)-pilocarpine and Timolol
Indirect anticholinesterase Inhib-esopto eserine,humorsol
Beta block-(dec aqueous humor produc) timoptic (Timolol), betagen(levobunolol)
Carbonic anhydrous inhib-(dec aque humor prod)-acetazolamide(diamox)
Osmotic diuretics-dec plasma vol. glycerol, mannitol

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9
Q

What are the 4 disorders of the posterior chamber?

A

Retinal detachment
Mac. Degen.
CMV retinitis
Retinitis pigmentosa

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10
Q

What are tx for retinal detachment?

A

Sclera buckle
Laser photo coagulation
Cryotherapy

Vitrectomy

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11
Q

What occurs in macular degeneration?

A

2 types:central vision deficit, retain periph, no cures.

Dry-outer layers break down causing drusen (yellow spots beneath retina)
Wet-proliferation of abnormal blood vessels growing under retina.

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12
Q

What occurs with cytomegalovirus (CMV) retinitis?

A

Common in AIDS
Related to herpes
Tx w/ antivirals

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13
Q

What occurs in retinitis pigmentosa?

A

Genetic disorder
Initial manifestation
No cure/tx

(Black periph)

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14
Q

Lastly, what are the ocular emergencies?

A

Trauma
Foreign bodies
Chem burns-irrigate!

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15
Q

What factors are important to assess pre operative?

A 
Health hx
Baseline 
V/s
Nutrition
Culture/rel.
Dentition
Drugs/alcohol/smoking use
Medications (notify anesth w/ antisz and BP)
Dz's/disabilities
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16
Q

What are some necessary assessments in PACU?

A

Resp-hypo pharyngeal obstruction, sleep apnea./resp. Rate/depth, o2 sat, breath sounds
Cardiovas.-hypoten, shock, hemor, HTN/dys.
Neuro-pain, N/v, loc, body temp
Dressing, IV site, tubes, elimination, positioning, then
H to T assess AP/Lat.
Aldrete score.

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17
Q

What are some complications to be aware of post op?

A 
Shock-Inc. HR, dec BP
Hemor.
DVT-clot
Pulm emb-at risk: female on BC, smokers, h/o clots
Resp comps-change in sounds
Urinary reten
Gastrointen
Wound
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18
Q

Before advancing to outpt extended care or unit from PACU, surgical patients should:

A

Awake, oriented, alert, easily aroused by verbal stimuli.
Patent airway, maintain blood o2 92% room air.
Active airway protective reflex.
Hemo dynamically stable w/ acceptable v/s for 15-30min.
No active bleeding.
Controlled pain.
Free from vomiting.

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19
Q

What is bone, purpose, and two types?

A

Connective tissue
Ground substance contains calcium salts (makes bone rigid)
Blocks o2 and nutrient diffusion (periosteum, haversion/volkmanns canals)
Cancellous-sponge like
Compact-cortical layered

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20
Q

What are 4 types of bone cells?

A

Osteoprogenitor cells-undifferentiated.
Osteoblasts-bone building (ossification/calcification(alkaline phosphatase)=healing)
Osteocytes-mature (derived from blasts)
Osteoclasts-bone resorption (bone chewing)

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21
Q

What is required for bone maintenance?

A 
Weight bearing activity
Absorption of 1000-1200mg calcium daily
Blood supply
Hormonal contro (PTH, Calcitonin) vitamins (Calcium, Vit D)
Bone remodeling
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22
Q

What happens if bone Mait isn’t functional?

A

Osteopenic (weak bones) low bone mass

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23
Q

What hormone regulates calcium and phosphate levels in the blood? How? What stimulates this hormone? What does this hormone stimulate?

A

PTH
Prevents serum calcium levels from falling and phosphate from rising above normal. (Bone resorption, conserving at the kidney, intestinal absorption, and reducing phosphate)
Decreasing CA
Vit D activation by kidney

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24
Q

What hormone is released by the thyroid gland when blood calcium is too high? What does it inhibit?

A

Calcitonin
Osteoclasts (prevents ca from leaving bone)
Vit D activation and Calcium resorption by kidneys

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25
Q

What is Vit D needed for? What are the two sources and By what two ways is it activated? Explain.

A

Absorb dietary calcium.
Intestinal absorp-jejunum (fish, liver, milk)
Skin production-ultraviolet radiation from sunlight
Then
Liver to kidney

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26
Q

What are 4 other hormones related to bone maintenance?

A

TH-increased level will increase bone resorption
GH-Increases bone remodeling
Estrogen-stims osteoblasts, inhibs osteoclasts (resorption)
Testosterone-inc skeletal growth/bone mass, converts to estrogen

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27
Q

What are the 2 types of bone marrow and what bones are they located?

A

Yellow-long bones shaft
Red (hematopoiesis) -spongy, flat bones, medullary of long bone (sternum, illeum, vertebrae, rib)
Wbc/RBC productions

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28
Q

Diff flaccid vs spastic.

A

Muscles are always in a state of readiness called tone.
W/O tone=flaccid (atone)
Inc tone=spastic (hypertonic)

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29
Q

What would you assess for in musculoskeletal system?

A

Pain-Types, describe, started, relief, worse, rate, radiate.
Edema
Sensation (numbness/tingling)-compare to unaff ext., neurovascular
Color/temp/cap refill
Pulse (and distal to affected area)
Crepitus
Spasms/stiffness-ROM
Appearance-deformities, alignment, shortening
Health hx-past, nutrition, lifestyle, comfort, meds, genetics, surg/tx’s
Posture/gait-kyphosis (resorption), lordosis, scoliosis

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30
Q

Diff the types of pains.

A

Bone-deep dull (not usual w/ movement)
Muscle-sore ache
Fracture-sharp piercing (relief by immobility)
Joint-worse w/ movement Effusion-excessive fluid in capsule

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31
Q

What are the tests of sensation and movement of peripheral nerve function? Name the nerves.

A

1st Sensation. 2nd Movement.
Peroneal:
prick between great and second toe.
Dorsiflex and extend toes (damage can have foot drop)
TIbial: prick medial and lateral surface of sole.
Plantar flex toes and foot.
Radial: prick between thumb and second finger.
Stretch out thumb, then wrist, then fingers at metacarpal joint
Ulnar:prick distal fat pad of small finger
Abduct all fingers
Medial:prick top or distal surface of index finger
Touch thumb to little finger, flex wrist

32
Q

What are the 5 P’s of circulatory checks?

A 
Pain
Paresthesia
Paralysis
Pulse
Pallor
*also temp
33
Q

What CBC labs are important in musculoskeletal function w/ values?

A 
Hemoglobin:
Male 13-18 g/DL
Female 12-16
Hematocrit:
Male 42%-52%
Female 35-47
WBC adult 4500-10000
WBC w/ diff: % of the total number of RBC's
34
Q

What are the coagulation studies and values?

A

(Oral anticoagulant)PT (prothrombin time)
9.5-12 seconds
(Heparin)PTT (partial thromboplastin time)
20-39 seconds
INR (international normalized ratio)
1.0 (related to PT)

35
Q

What are the three serums for blood chemistry?

A

Serum Calcium:
Most abundant cation
Elevated CA = metastatic bone dz, prolonged immobility, mult. Fx’s
Decreases CA=low albumin (malnutrition), chronic renal failure (phosphorus retention)
Serum Osteocalcin:
Biochem marker of bone metabolism
Serum Phosphorus:
Intracellular anion, 80% combined w/ calcium
Inverse to calcium (while one is high other is low, visa versa)
controlled by PTH, ca, renal excretion, intes absorp.
Inc level=bone tumor, healing fx, renal failure, hypoparathyroidism, hypo calcemia.
Dec level=hyperparathyroidism, osteomalacia, malnutrition.

36
Q

What enzymes are monitored to detect problems?

A 
Bone enzyme:
alkaline phosphatase (ALP)-inc = bone build up occurring (osteoblasts) for Cancer, metastatic. 
Muscle enzyme:
Aldolase (ALD) serum
Creatine phosphokinase (CPK/CK)
Both: skeletal muscle damage=inc level.
37
Q

What are the blood tests for Rheumatic d/o’s?

A

Rheumatoid Factor (RF)-determines presence of abnormal antibodies (attacks joints)-pos w/ presence of RA
LE Prep/Antinuclear antibody (ANA)-measures antibodies that react w/ a variety of nuclear antigens (destroying nucleus of self)
Erythrocyte sedimentation rate (ESR)-measures the rate at which RBC’s settle out of unclotted blood in 1 hour (15-30mm/h)
C-relative protein (CRP)-shows presence of glycoproteins due to inflam process

38
Q

What other 2 lab studies can be done for musculoskeletal not concerning blood?

A

24 HR urine collection-for calcium elevation (in osteolytic d/o)

Synovial fluid analysis-arthrocentesis (joint aspiration) for RA, complements, WBC, and glucose.

39
Q

What are 3 types of immobilization devices?

A

Cast (splint and brace)
External//internal fixation
Traction

40
Q

What are two types of cast materials and diff them.

A

Plaster-give off more heat, dries 24-72 hrs, handle with palms, and rest on pillow

Fiberglass-lighter, stronger, water resist., sets in 5 min., more common

Can apply ice as ordered, do ROM exercises, check NV status (blue-dec venous return, pale/cold-arterial obstruction), six P’s, be aware of pressure areas (bony prom)

41
Q

What are 3 complications associated with casts?

A

Compartment syndrome-increased pressure from cast and muscle compart, compromises blood flow, then low tissue perfusion leading to poss. Ischemia and neuromuscular damage w/I hrs.
S/s:pallor, cool, poor cap refill, paresthesia, unrelieved pain also w/ passive rom. LOWER TO LEVEL OF HEART, AND CALL PROVIDER WHICH MAY REMOVE OR BIVALVE
Disuse syndrome-muscle atrophy leading to deteriorated body systems. HAVE PT CONTRACT ISOMETRIC hourly.
Skin breakdown-hot spots, tissue necrosis possible, window cut

42
Q

What are the 2 forms of traction?

A

Skin-indirect, applied to skin prior to surg.
Ext:4.5lbs-8lbs
Pelvis:10-20lbs
Skeletal-direct, applied to bone w/ pins drilled thru skin, pulley/rope
Contin-15-25lbs
*mon. Nv status/lung and bowel sounds q4hrs, weights rem per md order, shift weight q1hr, rom 3-4qday, pin site asses q8hr/care 1-2qday

43
Q

What are 5 types of skin traction?

A 
Bucks-mostly hips
Russell's-tibial plateau fx, heel off bed, better rotation control, small motion of knee/hip
Bryants-femur fx (children 2 and under)
Dunlops-upper extremity
Pelvic-muscle spasm/fx's in low back
44
Q

What is to be expected with a patient on a fixation?

A 
Sutures and drain
V/s, o2, Nv checks q2-4hrs
Incentive spirometer
Turn, cough, deep breathe
Positioning
Rom 3-4 times day
Amb on 2nd day
Mon labs, compare to preop 
Aseptic pin care
Notify if pins/clamps loose
45
Q

What are complications of immobility?

A 
Ileus
Constipation
Anorexia
Pneumonia
Renal calculi
UTI
DVT
46
Q

What is the process of bone healing s/p fx?

What influences this rate? (10-18weeks)

A

1.Fx hematoma (torn vessel in periosteum)
Inflammation/revascularization
Reparative phase (granulation tissue)
Ossification of callus (osteoblasts and mineralization)
Remodeling (resorption)
2. Fx type
Blood supply
Surface contact of fragments (casts, etc)
General health

47
Q

What are the s/s of fx?

A 
Pain
Loss of function, rom
Deformity
-edema and ecchymosis 
-shortened limb and rotation 
-discoloration
-crepitus
48
Q

What is the emergency management of a fx?

Then clinical management.

A 
Immobilize injury area including joints proximal and distal.
Apply splint
Assess nv stats prior and post splinting (compare to other ext)
Open fx-cover w/ sterile dressing
2.asses (inspect/palpate)
Diag text (X-rays)
Apply ice as ordered, rest, above heart 
RICE!
49
Q

What are complications of fx’s?

A

Infection-higher risk w/ open
Shock (hypovolemia-hemorrhage)
Fat embolism 24-72 hrs post surg. (long bones, mult fx’s, crush)-sob, hypoxia, confus, tachycardia/Pnea, chest pain, pallor, petechiae (nip to face), personality changes (call MD, VENT, O2, ICU)
Compartment syndrome-fasciotomy procedure, swollen hard
DVT-lack of muscle contract/bed rest, warmth red pain edema
DIC-coag factors used up making massive bleed
Delayed Union/non Union-caused by infection, poor diet, not listen
Renal stones (serum ca inc.)-inc serum cal

50
Q

Define contusions strains and sprains.

A

Contusion-soft tissue
Strain-pulled muscle, overuse, excessive stress
Sprain-injury to ligaments surrounding joints

Tx: RICE

51
Q

What are the two areas of hip fx? Explain the diff.

A

Intracapsular-neck break-dec. blood flow leads to avascular necrosis, bone ischemia.
Extra capsular-better healing, risk for splintering (communiated)

52
Q

What are s/s for hip fx?

A 
Deformity:shortened, addicted, externally rotated
Crepitus (bone to bone)
Pain (hip, groin, medial)
Immobility 
Muscle spasm
Edema
Ecchymosis/bleeding
53
Q

What are some medical managements for hip fx’s?

A

Bucks extension
Surgical tx:
open/closed reduction and internal fixation
Hemiarthroplasty (bone grow around, half joint replaced)
Closed reduction w/ per cutaneous stabilization
THR

54
Q

What are some potential complications with hip fx?

A 
Hemorrhage
Peripheral neurovascular dysfunction
DVT
Pulmonary comps
Pressure ulcers
55
Q

What are nursing interventions s/p hip surg?

A

Avoid hip dislocation.

  • keep leg abducted, wedge/pillows, turn pt to unaffected side
  • do not flex hip more than 90 deg.
  • HOB 60 deg or less
  • avoid internal rotation
  • avoid crossing legs
  • assess for dislocation, notify md asap if suspected
  • hip pre caut. 4 months
56
Q

What are the typical wound drainages s/p THR?

A

Portable suction device: drains fluid/blood

  • 200-500ml in 1st 24hrs
  • active bleeding indicated if more than 250ml in first 8hrs (and bright red)
  • 30ml drainage over 8hrs by 48 hrs p/o
  • auto transfusion drainage system (blood to be used w/I 6 hrs of collection)
57
Q

What are the s/p knee replacement nursing interventions?

A 
Compression bandage
Ice
Nv status checks
Promote active flexion of foot
Drain care (hemovac), wound care
No pillows under knee
Positioning, CPM device
Pain management
Ambulation same day
Prevent comps:thromboemb., peroneal nerve palsy, infection, LROM
58
Q

What are the possible etiologies of RA?

A 
Viral
Bacterial
Immune response of antibodies (attacks joints)
Predisposition
*originates in synovial tissue
59
Q

What is the patho of RA? 4 steps

A

Synovitis:edema and congestion thicken tissue
Pannus formation:granulation tissue (causing pain)
Fibrous ankylosis:fusion
Boney ankylosis:calcification

60
Q

RA can be manifested in what ways?

A

Onset can be acute or chronic (insidious) w/ course marked by periods of remission and exacerbation.
Progressive:Deforms-swan neck, ulnar drift, contractures, nodules(SubQ)
S/s:Bilateral/symmetric
Joint stiffness/pain and fatigue
LROM
Systemic-enlarged spleen, lymph nodes, weakness, depression, sjogrens syn (dry eye/mucous mems)

61
Q

What diagnostics are useful in RA determination?

A 
Clinical manis
Labs: RF (pos)
ESR, CRP (sig elevated in acute phases)
Complement c3, c4 (decreased)
CBC
ANA (pos)
Arthrocentesis (milky, yellow, w/leukocytes/complement)
X-ray (bony erosion, narrow joint spaces)
62
Q

What are pharm management for RA?

A

Salicylates: (asp)
NSAIDS: (Ibprofen, naproxen, indomethacin)
DMARDS:Methotrexate, adalinmumab, hydrochloroquine
Corticosteroids: prednisone

63
Q

What are clinical managements for progressive erosive RA?

A

surgery: for uncontrolled pain
Synovectomy:removes synovial membrane
Arthroplasty:replacement
Arthrodesis:fusion

Low dose corticosteroid therapy
Intra articular cortico injections

64
Q

What are the 3 types of SLE (systemic lupus erythmatosus)?

Autoimmune dz, chronic inflammatory

A

Discoid-skin/face
Drug induced-may effect brain/kidney
Systemic lupus erythematosus (lupus)

65
Q

What is the patho for lupus (SLE)?

A

Dec T lymphocytes
Syn of immunoglobulins and auto antibodies
Immune complex formation
Tissue damage (all)

66
Q

What are s/s of lupus?

A 
Skin rash (may be provoked w/ sun exposure)
Joint pain sim to RA
Fatigue
Mouth and throat ulcers
Hair loss
Fever
67
Q

What are the diagnostics and tx’s for lupus?

A

No single test: Clin manis, h/p, ANA blood test

No cure

68
Q

What differs osteoarthritis from RA

A 
Common
Still chronic
NON inflam
NON systemic 
(Joints lose cartilage, mostly WB joints)
69
Q

What is the patho for osteoarthritis (DJD)?

A

Articular cart thins, breaks down damaging underlying bone stim growth, forming osteophytes (bone spurs) on articular surface.

70
Q

What are the OA Clin manis?

A

Joint pain/stiffness
Bony enlargements:
Heberdens nodes DIP (distal interphalangeal joint)
Bouchards Nodes PIP (proximal interphalangeal joint)
Crepitus
Effusion

71
Q

What pharms/surgical tx’s can be useful in OA?

A 
Analgesics-acetaminophen
Cox 2 inhib-celecoxib 
Muscle relaxants-cyclobenzaprine
Steroids:infra articular injection
Opiates
Osteotomy:altars weight distribution in joint
Arthroplasty:replacement
Debridement: bone spurs
Arthrodesis:fusion
72
Q

What is gout?

What can increase occurrence?

A

Inflam D/o which purine metabolism is altered, UA is deposited and accumulates in and around joints.(tophi-mono sodium rate crystals deposits in joints). Hyperuricemia:over production urate or dec renal excretion of urate

Inc ETOH intake, obesity, excessive weight gain

73
Q

What are gouts diagnostic findings?

A 
Clin symps
Serum UA levels (norm 1-6)
WBC and ESR
24 HR urine UA level
X-ray
Synovial fluid aspiration
74
Q

What is osteoporosis?

A

Reduction of total bone mass, increased fragility, susceptible to fx. Resorption is greater than bone mass formation.

75
Q

What meds are useful in osteoporosis?

A 
Calcium/Vit d supps
Alendronate
Calcitonin/teriparitide
Raloxifene
Estrogen replacement therapy
76
Q

What is osteomylelitis?

A

Bone infection

77
Q

What are the post op interventions for amputation?

A 
Mon for Hemorrhage
Pos to prevent contracture:
1 24hrs elevate stump at intervals w/o pillow (elevate bed)
Turn q 2hrs
Legs together
Pain man (phantom)
Skin integ. Aseptic 
Rom trapeze
Nutrition

NUR 120 (6 decks)

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