w2 Flashcards
Nursing care: BPH
- prostate gland ___creases in size
- prostate gland grows inward, causing ______ of urethra and disruption of _________
- BPH d/t age and influence of ___________
Nursing care: BPH
- prostate gland increases in size
- prostate gland grows inward, causing narrowing of urethra and disruption of UO
- BPH d/t age and influence of androgens
Gonioscopy
Performed when high _____ is found
- determines whether ______ or _______ is present
- allows visualization where iris meets _______ (anterior)
Gonioscopy
Performed when high IOP is found
- determines whether open or closed angle glaucoma is present
- allows visualization where iris meets cornea (anterior)
s/s
- ranges from asymptomatic to acute, sever, inflammatory disease
- men
- asymptomatic and transient, w/ spontaneous resolution within 10 days
- Maybe burning with urination/ejaculation
- urethral discharge
- women
- yellow-green discharge w/ foul odor
- cervix – red, inflamed, strawberry appearance
- bleeding after sex
- dysuria
- vaginal itching
- pain with intercourse
Trichomoniasis
Cataracts
- Issue with the ___ (sits behind pupil)
- normal = changes shape as needed to help focus image and accommodate
- can become _____ and ____ with aging
- __creased visual acuity
- __creased accommodation
Cataracts
Issue with the lens (sits behind pupil)
- normal changes shape as needed to help focus image and accommodate
- can become cloudy and stiff with aging
- decreased visual acuity
- decreased accommodation
Trichomoniasis
- most common nonviral STD
- caused by protozoan parasite = Trichomoniasis vaginalis
- transmission – exposure to sexual fluids during vagina, anal, oral sex
- incubation period – ___ week – ___ months (or longer)
complications
- r/t untreated ________
- more likely to get another STI, esp ____
Trichomoniasis
- most common nonviral STD
- caused by protozoan parasite = Trichomoniasis vaginalis
- transmission – exposure to sexual fluids during vagina, anal, oral sex
- incubation period – 1 week – 3 months (or longer)
complications
- r/t untreated inflammation
- more likely to get another STI, esp HIV
3 eye drop types
- _______
dilates pupils, can see inside eye, increases IOP - _______
constricts pupils and lowers IOP - ________
accommodation paralysis, can see inside eye
- mydriatic
- miotic
- cycloplegic
BPH treatment: based on symptoms
- mild
- Watchful waiting
- Avoid _______ (tighten muscles in prostate = makes its harder for urine to leave bladder)
- Avoid _______ (tighten muscles in prostate = makes its harder for urine to leave bladder)
- Restrict evening fluids – r/t _______
- ______ void – after voiding, wait a moment, and try and void again - drug therapy
- 5 alpha reductase inhibitors – ________
- Alpha blockers – tamsulosin
- Combination therapy - herbal therapy
- Saw palmetto – no supporting evidence - non-invasive therapies – don’t need to know about
- invasive therapies/surgeries
___________
BPH treatment: based on symptoms
- mild
- Watchful waiting
- Avoid decongestant – pseudoephedrine (tighten muscles in prostate = makes its harder for urine to leave bladder)
- Avoid antihistamines – diphenhydramine (tighten muscles in prostate = makes its harder for urine to leave bladder)
- Restrict evening fluids – r/t nocturia
- Double void – after voiding, wait a moment, and try and void again
2 . drug therapy
- 5 alpha reductase inhibitors – finasteride
- Alpha blockers – tamsulosin
- Combination therapy - herbal therapy
- Saw palmetto – no supporting evidence - non-invasive therapies – don’t need to know about
- invasive therapies/surgery
- TURP – transurethral resection of the prostate
(2) STD dx =
nucleic acid amplification test (NAAT)
which STD is NAAT the gold standard dx?
trichomoniasis
chlamydia
trichomoniasis
__________ STD
- Bacterial infections
- caused by Treponema pallidum
- transmission – direct contact with ulcer “chancre” can be external or internal in genital area
- Can be transmitted to baby during pregnancy – high risk
- incubation period – 10-90 days
syphillis
Slit lamp test
Magnifies the anterior or posterior eye structures with low powered microscope?
Who gets this test:
- routine testing
- cataracts
- retinal detachment
- glaucoma
- macular degeneration
Slit lamp test
Magnifies the anterior eye structures with low powered microscope
Who gets this test:
X - routine testing
- cataracts – can see white/opaque lens
- retinal detachment
- distinguish between open-angle and closed-angle glaucoma
- macular degeneration
tests for each disease:
1. glaucoma
(4)
- cataracts
(3) - retinal detachment
(2) - macular degeneration
(1)
- gonioscopy
- IOP testing
- slit lamp test
- ophthalmoscopy
- glare testing
- Miniature eye chart/pocket chart
- glaucoma
- gonioscopy
- IOP testing
- slit lamp test
- ophthalmoscopy - cataracts
- slit lamp test
- glare testing
- Miniature eye chart/pocket chart - retinal detachment
- slit lamp test
- Miniature eye chart/pocket chart - macular degeneration
- slit lamp test
Benign prostate hyperplasia
T/F
- Associated with aging
- BPH does predispose person to prostate cancer
- digital rectal exam (DRE) purpose – estimate the prostate ___, _____, and ______
- prostate with BPH is symmetrical/asymetrical? enlarged/small? soft/firm? rough/smooth?
- indicated labs are urinalysis, C&S, and serum creatinine
- TRUS (trans-rectal ultrasound) Helps differentiate BPH from cancer
- if DRE and PSA are abnormal, next test?
- Only way to definitively dx prostate cancer is a biopsy via ____
T - Associated with aging
F - BPH doesn’t predispose person to prostate cancer
- digital rectal exam (DRE) purpose – estimate the prostate size, symmetry, and consistency
- prostate with BPH is symmetrically enlarged, firm, smooth
- indicated labs are urinalysis, C&S, and serum creatinine
T - TRUS (trans-rectal ultrasound) Helps differentiate BPH from cancer
- if DRE and PSA are abnormal, next test? TRUS
- Only way to definitively dx prostate cancer is a biopsy via TRUS
s/s
- men
- within a few days
- pain with urination
- purulent urethral discharge
- epididymitis – inflammation of the epididymis (tube at back of testicles that carry sperm)
- women
- asymptomatic or minor overlooked symptoms
- increased vaginal discharge
- dysuria
- frequency of urination
- bleeding after intercourse
- rectal
- mucopurulent rectal discharge
- anorectal pain
- bleeding
- pruritis
- painful bowel movement
gonorrhea
Imaging assessments for the eye are
Painless and require no special follow up:
- CT
- MRI
- radioisotope scanning
- ultrasonography
- gonioscopy
- CT
- MRI
- radioisotope scanning
- ultrasonography
X - gonioscopy
s/s BPH
lower urinary tract symptoms (LUTS) =
- inflammation or infection causing _________ symptoms
- Nocturia
- Frequency
- Urgency
- Dysuria
- Bladder pain
- Incontinence
whats usually 1st symptom?
- narrowing of urethra causing ________ symptoms
- __creased effort required as the bladder tries to empty through decreased urethra diameter
- __crease in caliber and force of urine stream
- Difficulty initiating a stream
- Intermittency – starting and stopping stream several times while voiding
- Dribbling at end of urination
-1. inflammation or infection causing irritative symptoms
- Nocturia – 1st symptom
- Frequency
- Urgency
- Dysuria
- Bladder pain
- Incontinence
- narrowing of urethra causing obstructive symptoms
- Increased effort required as the bladder tries to empty through decreased urethra diameter
- Decrease in caliber and force of urine stream
- Difficulty initiating a stream
- Intermittency – starting and stopping stream several times while voiding
- Dribbling at end of urination
BPH treatment: surgery
TURP (transurethral resection of the prostate)
T/F
- 2nd line surgical treatment for BPH
- Resectoscope inserted into urethra
- prostate tissue is removed/excised
- anesthesia – _____ or ______
- outpatient procedure
- post procedure – large 3-way indwelling catheter w/ 30 mL balloon, continuous bladder irrigation
F - Gold standard surgical treatment
T - Resectoscope inserted into urethra
T - prostate tissue is removed/excised
- anesthesia – spinal or general
F - inpatient procedure
T - post procedure – large 3-way indwelling catheter w/ 30 mL balloon, continuous bladder irrigation
retinal detachment treatments
- which 2 are the Main methods used to seal retinal breaks
Both work by creating inflammatory reaction that causes adhesion/scar to seal the retinal break - _________
- Extraocular procedure
- Silicone patch wrapped around eye
- Indents the globe so that the eye ball moves toward the retina
- Usually under local anesthesia
- Outpatient procedure - ________-
- Intraocular procedure
- Gas bubble is injected into the vitreous cavity
- Patient needs to be positioned so that the bubble can apply max pressure on the retina by gravity (Often head down and to one side for several days to several weeks)
- Position depends on where bubble is
- Visual prognosis varies – based on extent, length, and area of detachment
- laser photocoagulation
- scleral buckle procedure
- cryopexy
- pneumatic retinopexy
- laser photocoagulation and cryopexy
- scleral buckle procedure
- pneumatic retinopexy
syphilis
- Bacterial or viral infection?
- caused by _____ _____
- transmission – direct contact with “______” can be external or internal in genital area
- Can be transmitted to baby during pregnancy?
- incubation period – ___ - ____ days
complications
- chancre (early) increase risk of ___ transmission
- high risk of ___ involvement (if syphilis and HIV positive)
- _____ syphilis – permanent damage with CNS, vision, dementia
- _____ syphilis – chest pain, dyspnea, murmur, cardiomegaly
- ______ syphilis – scarring on skin, changes in nasal septum and palate
- Bacterial infections
- caused by Treponema pallidum
- transmission – direct contact with syphilitic ulcer “chancre” can be external or internal in genital area
- Can be transmitted to baby during pregnancy – high risk
- incubation period – 10-90 days
complications
- chancre (early) increase risk of HIV transmission
- high risk of CNS involvement (if syphilis and HIV positive)
- neurosyphilis – permanent damage with CNS, vision, dementia
- CV syphilis – chest pain, dyspnea, murmur, cardiomegaly
- gummatous syphilis – scarring on skin, changes in nasal septum and palate
Prostate cancer treatment
- early stage
-Watchful waiting
-Repeated ___ and ____ - surgical therapy
–radical prostatectomy
-s/e – _________ (temporary ~24 months) and __________ (temporary ~ few months) - radiation therapy
- alone or with surgery and hormone therapy
- external (____therapy)
- internal (____therapy) - drug therapy
- ________ deprivation therapy
- _______therapy for metastasis
- early stage
- Watchful waiting
- Repeated DRE and PSA - surgical therapy – radical prostatectomy
- s/e – erectile dysfunction (temporary ~24 months) and urinary incontinence (temporary ~ few months) - radiation therapy
- alone or with surgery and hormone therapy
- external (teletherapy)
- internal (brachytherapy) - drug therapy
- androgen deprivation therapy
- chemotherapy for metastasis
glare testing
quantifies vision loss associated with ________
who gets this test:
- cataracts
- glaucoma
- retinal detachment
glare testing
quantifies vision loss associated with light scatters
who gets this test:
- cataracts (can also get Miniature eye chart/pocket chart)
X - glaucoma - ophthalmoscopy
X - retinal detachment - Miniature eye chart/pocket chart
eye disorders that are major causes of blindness
1st ______
2nd ______
1st cataracts,
2nd glaucoma
s/s
- Benign growths on anogenital skin or mucosa
- most people don’t know they are infected
- discrete warts – white, grey, flesh colored, hyperpigmented
- 1-10 warts, can coalesce together to make larger mass
- early lesions not detectable
- men – warts on penis or scrotum
- women – inner thighs, vulva, vagina, intra-anally
genital warts
genital warts treatment
- can be confused with other STI lesions, r/o other STI
- HPV _______ – cover genital warts and many strains that cause cervical cancer
- treatment goal = remove symptomatic _____
- Chemical or ablative methods in office
- Petroleum jelly on site, keep clean
- Patient applied treatment available
- Does removing warts decrease spread of HPV?
- _____ warts more difficult to treat
- long term follow up
- can be confused with other STI lesions, r/o other STI
- HPV vaccines – cover genital warts and many strains that cause cervical cancer
- treatment goal = remove symptomatic warts
- Chemical or ablative methods in office
- Petroleum jelly on site, keep clean
- Patient applied treatment available
- Removing warts doesn’t decrease spread of HPV
- Anal warts more difficult to treat
- long term follow up
STD transmission
T/F
- mucosal tissues in genitals, rectum, mouth
- skin to skin through casual contact
- skin to skin through sexual contact
- blood – birth
- blood - needles
- autoinoculation
T - mucosal tissues in genitals, rectum, mouth
F- skin to skin (not spread through casual contact)
T - skin to skin through sexual contact
T- blood - birth
T- blood - needles
T - autoinoculation – touching/scratching infected area and transferring to another part of same person’s body
PSA Nursing implication
- pt should be informed about _____ and _____ of PSA screening
-_______ – evaluation and treatment may be unnecessary
-________ – early detection of prostate cancer
PSA Nursing implication
- pt should be informed about risk and benefits of PSA screening
- Risks – evaluation and treatment may be unnecessary
- Benefits – early detection of prostate cancer
vision disorders
1.
Issue with the lens
- Etiology
- DM
- HTN - Eye disorder that increases IOP
- r/t retinal aging
- retinal break
Urgent situation
- cataracts
- retinopathy
- glaucoma
- macular degeneration
- retinal detachment
treatment for what vision disorder?
- laser photocoagulation
- cryopexy
- scleral buckle procedure
- pneumatic retinopexy
Repair of retinal detachment
Genital herpes
T/F
- Life long, incurable
- 2 strains - Herpes simplex (HSV1, HSV2)
- both can cause anogenital infections (genital and anus), but more commonly:
- HSV1 – _____ the waist
- HSV2 – _____ the waist
- HSV2 – more common in women
- Black and Hispanic pops more common to be infected
Complications
T/F
- neuro issues (Blindness, Encephalitis, Aspetic meningitis)
- genital ulcers increase risk of HIV
- can’t transmit to baby
Genital herpes
T - Life long, incurable
T - 2 strains - Herpes simplex (HSV1, HSV2)
T - both can cause anogenital infections (genital and anus), but more commonly
- HSV1 – above the waist, orolabial disease (cold sores, fever blister)
- HSV2 – below the waist, anogenital
T - HSV2 – more common in women
T - Black and Hispanic pops more common to be infected
Complications
T - neuro issues
- Blindness
- Encephalitis
- Aspetic meningitis
T - genital ulcers increase risk of HIV
F - can transmit to baby
Intraocular pressure (IOP) testing
Uses device that measures IOP = “_________” in which the covered end of probe touches anesthetized corneal surface
types:
- ________ applanation tonometer = gold standard
- tono-pen
Normal IOP = ___-___
Who gets this test:
- all patients >40 y/o
- anyone with family hx of glaucoma is tested once/twice per year
- cataracts
Intraocular pressure (IOP) testing
Uses device that measures IOP = “tonometer” in which the covered end of probe touches anesthetized corneal surface
- goldman’s applanation tonometer = gold standard
- tono-pen
Normal IOP = 10-21
Who gets this test:
- all patients >40 y/o
- family hx of glaucoma – tested once/twice per year
X - cataracts
BPH treatment: surgery
purpose of continuous bladder irrigation post procedure w/ TURP (transurethral resection of the prostate)
- prevent __________ r/t clots or mucus
- blood clots are expected first __ - __ hours
- rate of infusion (regulated by nurse) is based on the ____ of the urine
- urine flow should be ______ (color) without many clots
- large amounts of bright red blood may indicate __________ (trend color)
- if an increase in blood clot amount/size is noted = __crease infusion
- if an increase in bloodier urine is noted = __crease infusion
- ex: if pt stands for the 1st time, may see bloodier urine/clots = __crease infusion and when they get back in bed and color becomes light again, __crease infusion
- prevent obstruction r/t clots or mucus
- blood clots are expected first 24-36 hours
- rate of infusion (regulated by nurse) is based on the color of the urine
- urine flow should be light pink without many clots
- large amounts of bright red blood may indicate hemorrhage (trend color)
- if an increase in blood clot amount/size is noted = increase infusion
- if an increase in bloodier urine is noted = increase infusion
- ex: if they stand for the 1st time, may see bloodier urine/clots = increase infusion and when they get back in bed and color becomes light again, decrease infusion
genital herpes
T/F
- transmission – after contact with infected person via vagina, oral, anal sex, enters through mucus membranes or breaks in skin
- Can be dormant
- Outbreak – viral reactivation – occurs when virus descends to initial site of infection or other mucus membrane/skin
- HSV established permanent presence in dorsal root ganglia (in spinal nerve)
- Most contagious when infected person is symptomatic
- Most contagious when infected person has active lesions
- can’t be transmitted when person is asymptomatic
- can’t be transmitted when person has no active lesions
T - transmission – after contact with infected person via vagina, oral, anal sex, enters through mucus membranes or breaks in skin
T - Can be dormant
T - Outbreak – viral reactivation – occurs when virus descends to initial site of infection or other mucus membrane/skin
T - HSV established permanent presence in dorsal root ganglia (in spinal nerve)
T - Most contagious when infected person is symptomatic
T - Most contagious when infected person has active lesions,
F - can be transmitted when person is asymptomatic “asymptomatic viral shedding”
F - can be transmitted when person has no active lesions “asymptomatic viral shedding”
STD Risk factors
- >25
- socially/economically disadvantaged
- high risk behaviors
- alcohol/drug abuse
- needle sharing
- multiple sex partners
- condom use
- high risk medical hx
- hx of STI
- lack of vaccines
- multiple uses of HIV Prep (prophylaxis)
- high risk populations
- men sex men
- transgender
- WSW
- black
F - <25
T - socially/economically disadvantaged
T - high risk behaviors
T - alcohol/drug abuse
T - needle sharing
T - multiple sex partners
F - lack of barrier methods
T - high risk medical hx
T - hx of STI
T - lack of vaccines
T - multiple uses of HIV Prep (prophylaxis)
T - high risk populations
T - men sex men
T- transgender
T - WSW
T - black
- Neonates – gonococcal conjunctivitis
which STD is this a complication for
gonorrhea
chlamydia treatment
- Lab test – ________
- always test for other STIs as well
- high risk pops should get regular screens
- return for testing __ months after treatment
- meds = _________ and _________
- notify/eval/treat sex partners past __ days
- abstain for __ days after treatment and until all partners have been tested/treated
- nucleic acid amplification test (NAAT)
- always test for other STIs as well
- high risk pops should get regular screens
- return for testing 3 months after treatment
- azithromycin and doxycycline
- notify/eval/treat sex partners past 60 days
- abstain for 7 days after treatment and until all partners have been tested/treated
genital herpes treatment
T/F
- dx with s/s
- culture active lesion – can distinguish HSV 1 or 2
- psychological impact – not curable, refer to counsel
- _______ meds – acyclovir:
- Can’t shorten duration of outbreak
- Can suppress outbreaks
- Keep lesions dry and clean
T - dx with s/s
T - culture active lesion – can distinguish HSV 1 or 2
T - psychological impact – not curable, refer to counsel
- Antiviral meds – acyclovir
F - Can shorten duration of outbreak
T - Can Suppress outbreaks
T - Keep lesions dry and clean
- most common STD
- 2nd most common STD
- most common nonviral STD
- Life long, incurable STD
chlamydia
gonorrhea
Trichomoniasis
Genital herpes
Miniature eye chart/pocket chart
- measures _____ vision
- hold ___ inches from eyes
Who gets this test:
- routine screening
- cataracts
- retinal detachment
- glaucoma
Miniature eye chart/pocket chart
- measures near vision
- hold 14 inches from eyes
Who gets this test:
- routine screening
- cataracts
- retinal detachment
X - glaucoma gets opthalmoscopy
Genital warts
- Caused by ________
- transmission - sexually transmitted (skin to skin)
- incubation period – _____ - _____
T/F
- HPV is transient – fungus resolves in 1-2 years
- can persist even when warts aren’t present
- removing warts does help clear/treat virus
Complications
- few long term concerns
- high risk HPV strains highly linked with _____, need more screenings
- psychosocial burden
Genital warts
- Caused by Human papillomavirus (HPV)
- transmission - sexually transmitted (skin to skin)
- incubation period – months – years
F - HPV is transient – virus resolves in 1-2 years
T - can persist even when warts aren’t present
F - removing warts doesn’t help clear/treat virus
cancer
Gonorrhea
- 2nd most common STD
- caused by Neisseria gonorrhoeae, gram negative, diplococcus bacteria
- transmission – exposure to sexual fluids during vagina, anal, oral sex
- incubation period – ___ - ___ days
- can be infected multiple times
Sites
- common infection site for men –______
- common infection site for women – _____
- sites can also be rectum or oropharynx
complications are higher in males or females?
1-14
Sites
- common infection site for men – urethra = urethritis
- common infection site for women – cervix = cervicitis
- sites can also be rectum or oropharynx
since men are symptomatic – more likely to get treatment, not have complications
(men can have infertility with epididymitis)
since women are asymptomatic – less likely to get treatment, more likely to get complications
- batholins gland – located behind labia
- PID
- Pregnancy complications
- Neonates – gonococcal conjunctivitis
s/s
- early
1. Primary (highly infectious) – chancre lesions appear and last 3-6 weeks
2. Secondary (highly infectious) – starts 2-8 weeks after primary, bacterial dissemination – starts to affect nerves (ex: meningitis), rash
3. latent (not contagious, except thru preg) – asymptomatic for 2 years
- late
4. tertiary (not contagious) – asymptomatic for 1-20 years after initial infection, tissue/organ damage 10-20 years after beginning of latent stage
syphillis
Nursing care: chronic open angle glaucoma
- 1st line therapy = meds
- Eye drops that __crease aqueous humor production, or cause trabecular meshwork to open, etc.
- Compliance may be issue with eye drops if asymptomatic - if drug therapy is not sufficient = argon ______ trabeculoplasty (ALT)
- Outpatient procedure
- Topical anesthetic
- Laser hits damaged __________ and opens ___________
Nursing care: chronic open angle
- 1st line therapy = meds
- Eye drops that decrease aqueous humor production, or cause trabecular meshwork to open, etc.
- Compliance may be issue with eye drops if asymptomatic - if drug therapy is not sufficient = argon laser trabeculoplasty (ALT)
- Outpatient procedure
- Topical anesthetic
- Laser hits damaged trabecular meshwork and opens outflow channels (unclogs sink)
gonorrhea treatment
- culture discharge
- begin treatment without results
- Single high dose IM injection of ________ – best option right now r/t abx resistance of n. gonorrhoeae
- notify sex partners past __ days
- abstain for __ days after treatment and until all partners have been tested/treated
- culture discharge
- begin treatment without results
- Single high dose IM injection of ceftriaxone – best option right now r/t abx resistance of n. gonorrhoeae
- notify sex partners past 60 days
- abstain for 7 days after treatment and until all partners have been tested/treated
syphilis treatment
dx:
- blood test
- screening (VDRL)
- confirmatory positive screening (trepenemal antigens)
- timing of infection can give false results – multipe tests indicated
- HIV testing recommended
drugs:
- _______ G benzathine for all stages
- if allergy – ______ or _______
follow up:
- sex partner follow up past __ days
- HCP follow up q _ months for _ years
- repeat HIV test
DX and treatment
- blood test
- screening (VDRL)
- confirmatory positive screening (trepenemal antigens)
- timing of infection can give false results – multipe tests indicated
- HIV testing recommended
- penicillin G benzathine for all stages
- if PCN allergy – doxycycline or tetracycline
- sex partner follow up past 90 days
- HCP follow up q 6 months for 2 years
- repeat HIV test
Acute interventions: closed angle glaucoma
- requires quick drug intervention
- to treat acute pain:
- If light sensitive - darken room before or after pupils are fully constricted?
- Cool or warm compress to forehead?
- Quiet/private environment - Keep pt and family informed, supported
Acute interventions: closed angle glaucoma
1. requires quick drug intervention
2. to treat acute pain:
- If light sensitive - darken room after pupils are full constricted
- Cool compress to forehead
- Quiet/private environment
3. Keep pt and family informed, supported
STD drugs
abx - PCN, or doxycycline/tetracycline if PCN allergy
HPV vaccine
antiviral meds - acyclovir
antifungal meds - ______azole
Single high dose IM injection of ceftriaxone
abx - azithromycin and doxycycline
syphilis
gential warts
genital herpes
trichomoniasis
gonorrhea
chlamydia
scleral buckle procedure for retinal detachment: Post op care
- position
- Maybe bedrest
- Keep HOB flat or elevated AAT?
- Other positions may be ordered - topical eye ointments
- Abx
- Anti-inflammatories
- Dilating or constricting agents? - activity restrictions – to prevent increased IOP = T/F
- Don’t bend
- Don’t strain
- Don’t do vigorous exercise for 3-4 weeks
- position
- Maybe bedrest
- Keep HOB elevated AAT – prevents IOP
- Other positions may be ordered - topical eye ointments
- Abx
- Anti-inflammatories
- Dilating agents - activity restrictions – prevents IOP
T - Don’t bend
T - Don’t strain
T - Don’t do vigorous exercise for 3-4 weeks
2 types of glaucoma:
- _________
- the trabecular meshwork (spongy tissue) slows the drainage of the aqueous humor which increases IOP
- aqueous humor is reabsorbing (not draining)
- asymptomatic - ___________
Structural problem
- the angle formed by the iris and cornea is too narrow and prevents aqueous humor from draining which increases IOP
- painful red eye
- must be treated within 24 hours or blindness may be permanent
open-angle - “clogged kitchen sink”
closed-angle - “small kitchen sink”
s/s
- primary episode (never had it before)
– incubation 2-12 days - No recognizable s/s
- Regional lymphadenopathy
- Systemic flu like symptoms
- 3 week process
- recurrent episode – (occurs within the 1st year after primary episode)
- Less severe
- Heals quicker
- Decreased episodes over time
- Triggers of recurrent episodes – stress, fatigue, acute illness, sunburn, immunosuppression
genital herpes
Ophthalmoscopy
- use of an ophthalmoscope, a handheld device with a light source and magnifying lens, allows view into ______ of the eye
(inner or outer surface of the eye)?
- red reflex
- optic disc
- optic blood vessels
- fundus
- macula
- darken room to ______ pupil
- move in from 15 inches away to the side of patient line of vision = ________ vision
Who gets this test:
- routine physical exam
- glaucoma
- cataracts
- retinal detachment
Ophthalmoscopy
- use of an ophthalmoscope, a handheld device with a light source and magnifying lens, allows view into fundus of the eye (inner surface of the eye)
- red reflex
- optic disc
- optic blood vessels
- fundus
- macula
- darken room to dilate pupil
- move in from 15 inches away to the side of patient line of vision (peripheral)
Who gets this test:
- routine physical exam
- glaucoma
X - cataracts - Miniature eye chart/pocket chart
X - retinal detachment - Miniature eye chart/pocket chart
STD
Infectious disease spread through sexual contact with _______, ________, _________, or _________ from an infected person
penis, vagina, mouth, sexual fluids
cataracts: Post op care
T/F
- topical abx and steroids – given before going home
- eye covered with patch and eye shield, removed at initial post-op visit (72hours)
- topical abx and steroids drops – given to take home
- may have activity restrictions – r/t avoiding decreasing IOP
- may have night time eye patch
- avoid stooping, bending, lifting, coughing
- patient may initially experience improved or decreased vision – both are abnormal
- eye drops will be slowly decreased and stopped as eye heals
- Follow up visits to ophthalmologist next day, next week, and next month
Post op care
T - topical abx and steroids – given before going home
F - eye covered with patch and eye shield, removed at initial post-op visit (24hours)
T - topical abx and steroids drops – given to take home
F - may have activity restrictions – r/t avoiding increase IOP
- may have night time eye patch
T - avoid anything that can increase IOP – stooping, bending, lifting, coughing
F - patient may initially experience improved or decreased vision – both are normal
T - eye drops will be slowly decreased and stopped as eye heals
T - Follow up visits to ophthalmologist next day, next week, and next month
vision disorders
- All over haze
- Flood glare – d/t light scatter caused by opacities
- Splotchy haze
- Loss of peripheral vision
- loss of central vision
- sudden onset of multiple small floaters and/or flashes of light
- painless
- curtain coming across field of vision
- cataracts
- retinopathy
- glaucoma
- macular degeneration
- retinal detachment
2 forms of macular degernation:
- ____________
- most common form
- notice close/central vision tasks become more difficult
- macular cells start to atrophy – leading to progressive and painless vision loss over many years
- less threatening to vision loss
- smoking may increase risk of progression
- no proven effective treatment - ____________
- more severe form
- associated with AMD related blindness
- more rapid onset
- characterized by the development of abnormal blood vessels in or near macula
Dry (non-exudative)
Wet (exudative)
Retinopathy
Etiology
____
____
Prevention and treatment directed at keeping ____/____ under control and monitoring progression
Splotchy haze
- DM
- HTN
cataracts: Collaborative care
1. palliative measures
- adjust _______ prescription
- increase _______ for reading and close up work
- don’t drive at _____
2. surgery when:
- _______ options are no longer satisfactory
- lens is causing ___
- lens opacity prevents HCP from monitoring _____ in high risk persons like diabetics
Collaborative care
1. palliative measures
- adjust glasses prescription
- increase lighting for reading and close up work
- don’t drive at night
2. surgery
- when palliative options are no longer satisfactory
- lens is causing IOP
- lens opacity prevents HCP from monitoring retina in high risk persons like diabetics
Nursing care: acute angle closure glaucoma (closed)
- ocular emergency?
- _____scopy = gold standard for dx closed-angle glaucoma
- ED initial therapy goal = immediate relief
- Beta blocker topical agent
- Carbonic anhydrase inhibitor(acetazolamide) PO
- Miotic eye drops – _____ pupils, lowers ____
- Treat pain and nausea aggressively – can be causing increased ____
- Avoid activity
- Keep calm
- Patch/cover over affected eye
- Once IOP is stabilized – prepare for iri___omy - surgical intervention
- Laser peripheral iri___omy - laser procedure to create a small hole (dot) in the iris
- Surgical iri___omy - surgical procedure to remove a small piece of the iris (pie shaped)
Nursing care: acute angle closure glaucoma (closed)
- ocular emergency!!
- gonioscopy = gold standard for dx closed-angle glaucoma
- ED initial therapy goal = immediate relief
- Beta blocker topical agent
- Carbonic anhydrase inhibitor (acetazolamide) PO
- Miotic eye drops – constrict pupils and lowers IOP
- Treat pain and nausea aggressively – can be causing IOP
- Avoid activity
- Keep calm
- Patch/cover over affected eye
- Once IOP is stabilized – prepare for iridotomy - surgical intervention
- Laser peripheral iridotomy - laser procedure to create a small hole (dot) in the iris
- Surgical iridectomy - surgical procedure to remove a small piece of the iris (pie shaped)
2 forms of macular degeneration: wet/exudative vs dry/non-exudative
- most common form
- notice close/central vision tasks become more difficult
- more severe form
- less threatening to vision loss
- smoking may increase risk of progression
- wet leads to dry OR dry leads to wet?
- macular cells start to atrophy – leading to progressive and painless vision loss over many years
- associated with AMD related blindness
- more rapid onset
- characterized by the development of abnormal blood vessels in or near macula
- no proven effective treatment
- D
- D
- W
- D
- D
- dry leads to wet
- D
- W
- W
- W
- D
which eye disorders are emergencies?
closed-angle glaucoma
retinal detachment
Chlamydia
- most common STD
- caused by Chlamydia trachomatis
- transmission – exposure to sexual fluids during vaginal/anal/oral, most likely men to women
- incubation period __-__ weeks
- can be infected multiple times
Sites
- common infection site for men –
- common infection site for women –
- sites can also be rectum or oropharynx
complications
- _______ – mainly women
- ______ disease – women
Chlamydia
- most common STD
- caused by Chlamydia trachomatis
- transmission – exposure to sexual fluids during vaginal/anal/oral, most likely men to women
- incubation period 1-3 weeks
- can be infected multiple times
Sites
- common infection site for men – urethra = urethritis
- common infection site for women – cervix = cervicitis
- sites can also be rectum or oropharynx
complications
- infertility – mainly women
- Pelvic inflammatory disease (PID) – women
Visual acuity testing
Can measure near vision, far vision, or both
both
Retinal detachment
Urgent situation
s/s while detaching or after detachment?
- painless
- curtain coming across field of vision
s/s while detaching or after detachment?
- sudden onset of multiple small floaters and/or flashes of light
after
while
s/s while detaching
- sudden onset of multiple small floaters and/or flashes of light
s/s after detachment
- painless
- curtain coming across field of vision
cataracts: pre-op care
1. mydriatic drops
- admin by RN
- dilates or constricts pupils, or accomodation paralysis?
- punctual occlusion necessary? why?
- photophobia - do what?
2. cycloplegic drops
- admin by RN
- dilates or constricts pupils, or accomodation paralysis?
3. NSAID drops
4. anxiety meds
5. outpatient procedure
6. obtain medical hx
- if they have closed-angle glaucoma – don’t give _______ eye drops, can cause increased IOP
7. topical abx prophylactically – maybe
8. ___ 6-8 hours
pre-op care
1. mydriatic drops
- admin by RN
- dilates pupils
- punctual occlusion – putting pressure on inner eye which prevents systemic absorption of drops via tear ducts, systemic effects = CV effects
- photophobia – sensitivity to light, decrease room lights
2. cycloplegic drops
- admin by RN
- paralysis of accommodation
3. NSAID drops
4. anxiety meds
5. outpatient procedure
6. obtain medical hx
- if they have closed-angle glaucoma – don’t give dilating eye drops, can cause increased IOP
7. topical abx prophylactically – maybe
8. NPO 6-8 hours
snellen chart
- Measure _____ vision
- stand __ feet from chart
good or bad? - 20/20 = at 20 feet patient sees what healthy eyes should see at 20 feet
good or bad? - 20/50 = at 20 feet patients sees what healthy eyes should see at 50 feet
- Measure far vision
- stand 20 feet from chart
- 20/20 = at 20 feet patient sees what healthy eyes should see at 20 feet
- 20/50 = at 20 feet patients sees what healthy eyes should see at 50 feet (bad)
prostate cancer screening = ____ with/without ___
PSA
DRE
- glaucoma
- the optic disc has a “cup” which is usually _______, but with glaucoma the cup gets ______,
which test may see “optic disc cupping” - ophthalmoscopy or Miniature eye chart/pocket chart?
- the optic disc has a “cup” which is usually small, but with glaucoma the cup gets larger,
may see optic disc cupping with Ophthalmoscopy
serum prostate-specific antigen (PSA)
T/F
- PSA is a protein made only by prostate cells
- PSA is highly specific to prostate
- PSA is specific to prostate cancer
- Cancer and other non-cancerous conditions like BPH and prostatitis can affect PSA levels
- Controversy is r/t to PSA testing and the lack of specificity for prostate cancer
- all cancers require treatment
- Recommendations – begin screening at age 50 for average risk, stop screening >75 b/c harm > benefits
- Many men die from prostate cancer
- As screening becomes more widespread – smaller cancers are being found, early detection of aggressive cancer saves lives, most slow growing cancers don’t need to be treated
serum prostate-specific antigen (PSA)
T - PSA is a protein made only by prostate cells
T - PSA is highly specific to prostate
F - not specific to prostate cancer
T - Cancer and other non-cancerous conditions like BPH and prostatitis can affect PSA levels
T - Controversy r/t to PSA testing and the lack of specificity for prostate cancer
F - Not all cancers require treatment
T - Recommendations – begin screening at age 50 for average risk, stop screening >75 b/c harm > benefits
F - Many men die of other things before they would die from prostate cancer
T - As screening becomes more widespread – smaller cancers are being found, early detection of aggressive cancer saves lives, most slow growing cancers don’t need to be treated
Trich treatment
- dx lab test - __________ – gold standard, detects RNA
- treat w/ _________
- notify sex partners past ___ days
- abstain for __ days after treatment and until all partners have been tested/treated
- rate of recurrence low or high?
- more common in women or men?
- dx - nucleic acid amplification test (NAAT) – gold standard, detects RNA
- treat w/ antifungals
- metronidazole – 7 day course 2x/day… OR…
- tinidazole – single dose PO
- notify sex partners past 60 days
- abstain for 7 days after treatment and until all partners have been tested/treated
- high rate of recurrence – recommendation – get retested in 2 weeks – 3 months
- more common in women vs men (Routine screening for high risk women, not recommended for men)
s/s
- asymptomatic
- men
- pain with urination
- urethral discharge
- women
- mucopurulent discharge – mucus and pus
- bleeding
- dysuria
- pain with intercourse
- rectal
- anorectal pain
- discharge
- bleeding
- pruritis
- tenesmus – feeling or incomplete defecation
- mucus coated stools
- painful bowel movement
chlamydia
