Nurs 181 FINAL EXAM
Goal LDL Cholesterol:
<100mg/dL for all diabetics <70mg/dL for diabetics with CVD
Who should be tested for diabetes?
Begin everyone age 45 BMI>= 25 or 23( in Asian Americans) with risk factors Risk factors First degree relative with DM High risk ethnic group History of CVD High BP, low HDL cholesterol, high triglycerides Polycystic ovary disease Sedentary Obesity Prediabetes Women with GDM
What is the name of the bony socket of the skull that surrounds and protects the eye?
The orbit
The name of the opening in the center of the iris
The pupil
What is the name of the innermost layer of the eye that contained photoreceptors?
The retina
What is the external layer of the eye (the white of the eye?)
The sclera?
This is the medical term for the eardrum
Tympanic membrane
Bladder Scan
Ultrasound test used at the bedside for post void residual volumes
Reflux
Upward flow of urine toward the renal pelvis and kidney
Nocturia
Urination at night
Nursing Treatment Identify hypoglycemia
Give glucose If eating: 15 gm of carbohydrates If not eating and has IV access: D 50 If not eating and no IV access: Glucagon 1mg IM (side lying position as pt will vomit) **Can only give Glucagon once in 24 hours; does not work if have liver disease or starvation state**
Microvascular Complications- Nephropathy
Glomeruli damaged and leak protein into urine Leading cause of end-stage renal disease Prevention : Regular assessment for urine albumin and serum creatinine If proteinuria treat with ACE or ARB Optimize glucose and BP
Factors that promote hyperglycemia in the hospital?
Medications Stress of hospitalization, trauma, and acute illness TPN, Enteral Feedings
Hemoglobin A1c
No diabetes: around 5% Pre-diabetes 5.7%-6.4% Diabetes > 6.5%
Hospital Guidelines for non- ICU settings
Premeal glucose targets < 140mg/dL Random glucose levels < 180mg/dL Preferred method for maintaining control: Scheduled sub Q administration of insulin with basal, nutritional and correction components
Glasgow Coma Scale
Used to assess consciousness -specific and structured 3 indicators are evaluated: 1. opening of eyes 2. best verbal response 3. best motor response Highest score is 15; lowest is 3 ( 8 or less indicative of coma) A Coma Score of 13 or higher correlates with a mild brain injury, 9 to 12 is a moderate injury and 8 or less a severe brain injury.
These 2 nerves make up the 8th cranial nerve.
Vestibular and cochlear nerves
What vitamin deficiency can cause eye dryness, keratomalacia and blindness?
Vitamini A
The thick clear gel that fills the space between the lens and the retina
Vitreous humor
What is the name of the gel that fills the posterior 2/3 of the eye and maintains the eye's shape?
Vitreous humor
Lay person term for bacterial conjunctivitis is this...
"Pink eye"
Which direction do you pull an adults ear for examination?
(a) Pull ear pinna backward, up, and out for an adult. For children less than 3 years of age, pull pinna down and back; point
What changes occur with the eye and ear with aging?
***
Fasting Plasma Glucose
- Normal: <100mg/dl (less than 100) - Pre-diabetes: 100-126mg/dl - Diabetes: >126 mg/dl (more than 126)
Barret's esophagus
-damage to the lower portion of the tube that connects the mouth and stomach (esophagus) -usually the result of repeated exposure to stomach acid -often diagnosed in people with long-term GERD
Elisa Test
-enzyme linked immunosorbent assay that detects and measures antibodies in your blood
Osteomyelitis treatment
-pain and fever relief contact precautions hyperbaric 02 therapy wound care surgery-sequestrectomy(removal of dead bone) -microvascular bone transfers
Vagotomy
-surgical operation in which one or more branches of the vagus nerve are cut, typically to reduce the rate of gastric secretion
To prevent pin tract infection, pin sites should be cleaned with this solution.
What is chlorhexidine (0.9% sodium chloride is used in many agencies but has not been shown to be more effective)?
Rinne Test
1. Strike a tuning fork and places it near the base of the mastoid bone. 2. Ask the patient to say when he or she no longer hears the sound. 3. Note the time and move the tuning fork in front of the ear canal. 4. Ask the patient to say when he or she no longer hears the sound. 5. Compare the time intervals for the two steps. Normal hearing=air conduction time that is twice as long as bone conduction Conductive hearing loss=bone conduction sound is longer/equal to the air conduction sound Sensorineural=air conduction is heard longer than bone conduction, but it is not heard to be twice as long
Weber Test
1. Strike a tuning fork and places it on the middle of your patient's head. 2. Ask where the patient hears the sound is coming from: the left ear, the right ear, or both. Results Normal Hearing will indicate sound in both ears Conductive loss will indicate the sound travels towards the poor ear. Sensorineural loss will indicate the sound travels towards the good ear.
After a laminectomy, patients should be taught to contact the surgeon immediately if they notice this type of drainage coming from the wound.
What is clear drainage? Usually indicates a meningeal tear and CSF is leaking.
After any open back surgery, the nurse should assess for the patient's ability to __________________.
What is to void? Inability to void may indicate damage to the sacral spinal nerves which control the detrusor muscle in the bladder.
What is consensual response?
When constriction of the opposite pupil happens when light is shined in the other pupil
reflex urinary incontinence(aka overflow incontinence)
When the detrusor muscle fills to contract and the bladder becomes over distended-may be related to neurological impairment
normal IOP
10-21 mmHg
When assessing for correct crutch measurement, the elbows should be flexed this many degrees.
15 to 30 degrees
How far away should a patient stand from the eye chart when assessing vision?
20 feet
Dry-eye syndrome is more common among this gender
Women
Herniated disks occur most often between these lumbar vertebrae.
4th and 5th (L4-5) lumbar vertebrae
Name the 6P's that make up a neurovascular assessment
6 P's Pain ( excessive) Pulses Pallor (color) Paralysis ( movement) Paresthesias (numbness or tingling—sensation—can you feel this?) Poikilothermism ( temperature) or some books say pressure
BUN level
7-20 mg/dl Elevated BUN(azotemia) (> 23mg/dL)
This complication happens when blood supply to the bone is disrupted, leading to death of bone tissue.
avascular necrosis or osteonecrosis
Since opioid analgesics are not as effective for phantom limb pain, this type of drug might be prescribed (Name one).
beta blocker, antiepileptic, antispasmodic, or antidepressant
JNC 8 HTN guidelines
<120 AND <80 NORMAL 120-129 AND <80 NORMAL 130-139 OR 80-89 PREHYP 140-159 OR 90-99 STAGE 1 >=160 OR >=100
The nurse is admitting a client with multiple trauma injuries to the nursing unit. The client has a leg fracture and had a plaster cast applied. Which position would be best for the casted leg?
A casted extremity is elevated continuously for the first 24 to 48 hours to minimize swelling and promote venous drainage.
Trauma to the auricle resulting in a hematoma is often referred to as
A cauliflower or boxer's ear
Random (Casual) Plasma Glucose
A patient with hyperglycemic crisis or classic symptoms of hyperglycemia and a random plasma glucose >=200mg/dL
Which cast care instructions should the nurse provide to a client who just had a plaster cast applied to the right forearm?
A plaster cast takes 24 to 72 hours to dry (synthetic casts dry in 20 minutes). The cast and extremity should be elevated to reduce edema if prescribed. A wet cast is handled with the palms of the hand until it is dry, and the extremity is turned (unless contraindicated) so that all sides of the wet cast will dry. A cool setting on the hair dryer can be used to dry a plaster cast (heat cannot be used on a plaster cast because the cast heats up and burns the skin). The cast needs to be kept clean and dry, and the client is instructed not to stick anything under the cast because of the risk of breaking skin integrity. The client is instructed to monitor the extremity for circulatory impairment, such as pain, swelling, discoloration, tingling, numbness, coolness, or diminished pulse. The health care provider is notified immediately if circulatory impairment occurs.
What is the difference between a sprain and a strain?
A strain is a muscle injury; a sprain is a ligament injury
Medications or disorders that can affect eye
corticosteriods
This cranial nerve is the optic nerve
cranial nerve II
KUB
An x-ray of the kidneys, ureters, and bladder
Refractive error caused by unevenly curved surfaces on the eye
Astigmatism
Pyelonephritis
Bacterial infection in the kidney and renal pelvis
Habit Training (scheduled toileting)
Bladder training used to reduce incontinence in cognitively impaired patients
A client with a hip fracture asks the nurse about Buck's (extension) traction that is being applied before surgery and what is involved. The nurse should provide which information to the client?
Buck's (extension) traction is a type of skin traction often applied after hip fracture before the fracture is reduced in surgery. Traction reduces muscle spasms and helps to immobilize the fracture.
This is an opacity of the lens
Cataract
This is the most common cause of an impacted ear canal.
Cerumen
What are nursing interventions for patients on NSAID's?
Check for bleeding—dark, tarry stools Give NSAID's with meals or food Drink plenty of water Avoid alcohol Many herbal products interact with NSAID's and could cause bleeding(dong quai, feverfew, garlic, ginger, ginkgo
A client with diabetes mellitus has had a right below-knee amputation. Given the client's history of diabetes mellitus, which complication is the client at most risk for after surgery?
Clients with diabetes mellitus are more prone to wound infection and delayed wound healing because of the disease.
The spiral organ of hearing
Cochlea
Increased pressure in an area that can't expand causes this complication.
Compartment syndrome
Inflammation of the conjunctiva is known as this...
Conjunctivitis
A patient with osteomyelitis should be placed in this type of isolation.
Contact isolation
The ability to turn both eyes inward toward the nose at the same time is known as this...
Convergence
This is the name of the clear layer that forms the external bump on the front of the eye?
Cornea
A client being measured for crutches asks the nurse why the crutches cannot rest up underneath the arm for extra support. The nurse responds knowing that which would most likelyresult from this improper crutch measurement?
Crutches are measured so that the tops are 2 to 3 fingerwidths from the axillae. This ensures that the client's axillae are not resting on the crutch or bearing the weight of the crutch, which could result in injury to the nerves of the brachial plexus.
Hyponatremia
Deficiency of sodium (<135mEq/L) • Manifestations are primarily neurologic • Headache, change in mental status, lethargy, seizures • Muscle weakness • Tachycardia, hypotension or hypertension, bounding pulses (if hypervolemia) • Nausea, abdominal cramps, muscle weakness
Noninfectious cystitis
Due to chemical exposure or radiation therapy
This is the most common surgery for ocular melanoma
Enucleation (surgical removal of the entire eyeball)
EGD
Esophagogastroduodenoscopy-procedure that visualizes the upper part of the GI tract up to the duodenum
Types of Hypertension
Essential(primary): Most common No specific cause--Unhealthy lifestyle, genetics, etc. Secondary: Caused by an underlying condition(usually renal disease), congenital abnormality or drugs Generally returns to normal when the problem is corrected. Malignant Extremely high blood pressure that develops suddenly and rapidly and causes some type of organ damage. Gestational/Pregnancy induced hypertension(PIH) Elevated blood pressure during pregnancy
Blepharitis is an inflammation of this...
Eyelid
FAP
Familial Adenomatous Polyposis -inherited disorder characterized by cancer of the large intestine (colon) and rectum
A petechiael rash may appear on the neck, upper arms, chest and abdomen with this complication
Fat Emboli
Stercoraceous
Fecal vomiting
GERD
Gastroesophageal reflux disease -digestive disease in which stomach acid or bile flows into the food pipe and irritates the lining
Term for a group of eye disorders that result in increased ocular pressure (IOP)
Glaucoma
Diabetes HDL and triglyceride levels
HDL<35mg/dL or triglycerides 250mg/dL or >
What is the name for farsightedness?
Hyperopia or hypermetropia
This is the medical name for a hemorrhage in the anterior chamber that occurs when a force is applied to the eye and breaks the blood vessels.
Hyphema
Infectious organisms entering the bone from outside the body such as with an open fracture are categorized as this type of osteomyelitis.
exogenous
These are 3 key features of acute osteomyelitis.
fever, swelling, erythema, tenderness, constant bone pain
Urethritis
Infection in the urethra
Cystitis
Inflammation of the bladder
Walking with crutches upstairs and downstairs
good goes to heaven, bad goes to hell
What does tonometry measure?
Intraocular pressure (IOP)
Hyperkalemia Management
K restriction • Loop diuretics or Kayexalate • Cardiac monitoring • Insulin to move K back into cells • Emergency meds to counteract myocardial effects of ↑K • Safety measures for muscle weakness • Last resort-dialysis
Hypokalemia
K<3.5mEq/L Manifestations May be asymptomatic If symptoms related to muscular or cardiac function: · Skeletal muscle weakness (especially legs), could affect respiratory muscles (priority Life-threatening cardiac dysrhythmias and hypotension · Anorexia, nausea, vomiting paralytic ileus) · Digitalis toxicity →hypokalemia ↑ sensitivity of heart muscle to digoxin
Hyperkalemia
K>5.0 mEq/L Manifestations: • Early: paresthesias and muscle twitching, then later weakness • Hyperactive bowel sounds, nausea , cramping, diarrhea • Decreased heart rate, decreased cardiac output, irregular pulse, dysrhythmias, hypotension
dyspepsia
indigestion
The most common vision-enhancing surgery is this...
LASIK (laser in-situ keratomileusis)
LEFT SIDE STROKE
LEFT HEMISPHERE Right hemiplegia/paresis Right visual field deficits Aphasia Alexia/dyslexia Aware of deficits Impaired intellectual ability Slow cautious behavior High frustration over losses
Tears are produced in this gland
Lacrimal gland
What structure is behind the iris and in front of the vitreous body and bends the rays of light entering through the pupil?
Lens
avascular necrosis
interruption in blood supply to the bony tissue, results in bone death most common site femoral head, may have no symptoms or pain decreased ROM/sensation call physician, usually requires surgery to remove necrotic tissue CT/MRI
An example of this type of exercise would be lifting the heels while pressing the back of the knees against the mattress while in bed.
isometric exercise
Turning as a unit with the back kept as straight as possible after a laminectomy is known as this.
log-rolling
This complication of amputation involves a growth or tumor of damaged nerve cells.
neuroma
Oral Glucose Tolerance Test (OGTT)
normal: 140 mg/dL and below pre diabetes: 140-200 mg/dL diabetes: 200 mg/dL or above
This complication is most common with open fractures in which skin integrity is lost and after surgical repair of a fracture.
osteomyelitis
early signs of compartment syndrome
pain-out of proportion to the original injury paresthesias-numbness/tingling
late signs of compartment syndrome
pallor polar-cold temp paralysis pulses
This disorder of the foot, accounts for 10% of running injuries.
plantar fasciitis
After wrapping an amputated finger in dry sterile gauze (if available), this is the current recommendation for prehospital care to be provided next.
put the finger in a watertight sealed plastic bag and then place the plastic bag in ice water at 1 part ice, 3 parts water.
This used to be the primary purpose of Buck's skin traction and is still used by some providers for this purpose
relieve muscle spasms that accompany hip fractures
This term refers to a narrowing of the spinal canal, and is typically seen in people over age 50.
spinal stenosis
This disorder has 2 types: wet and dry
Macular degeneration
These are the 3 small bones of the middle ear
Malleus (hammer), Incus (anvil), stapes (stirrup)
Hypomagnesemia management
Management • Check for medications that cause ↓Mg • Dietary replacement • Oral replacement: may cause diarrhea • Severe: IM or IV replacement---check orders closely • Check for hypocalcemia and hypokalemia (both cause hypomagnesemia) • Monitor respiratory status—can cause laryngeal stridor • Monitor cardiac rhythm • Watch for dig toxicity (if on digoxin) • Seizure precautions • Safety precautions
Hypermagnesemia
Manifestations • Opposite of hypo: decreased muscle and nerve activity • Hypoactive deep tendon reflexes • Drowsy, lethargic • Weakness • Decreased heart rate • Vasodilation—decreased B/P, facial flushing
Retinopathy manifestations
Manifestations of retinopathy include changes in the blood vessels of the retina that can lead to blindness
Hypomagnesemia
Manifestations: • Similar to low potassium or calcium • Irritates the central nervous system • + Chvostek's sign • + Trousseau's sign Myocardial irritability, dysrhythmias • STARVED( s eizures, t etany, a norexia, r apid HR, v omiting, e motional lability, d eep tendon reflexes increased)
This is an infection of the air cells which are embedded in the temporal bone.
Mastoiditis
Estrogen
May be used to treat post-menopausal women with stress incontinence
Alcohol/Artificial Sweeteners
May cause temporary urinary incontinence
This is the most common malignant eye tumor
Melanoma
Endolymph is found here.
Membranous labyrinth
Retinal detachment are more common among this gender
Men
Management of hyponatremia
Mild: • restrict fluids—primary treatment for dilutional hyponatremia • oral sodium supplements • if hypovolemic: normal saline IV Severe • hypertonic 3% or5% saline (IV) given slowly and small volumes • Monitor neuro status • Seizure precautions • Check skin turgor
Catheters
Most common cause of UTI's in the hospital setting
Infectious cystitis
Most commonly caused by organisms from the intestinal tract
Aerophagia
the excessive swallowing of air while eating or drinking, and is a common cause of gas in the stomach
Aside from drainage from the affected area and local pain, this is a key feature of chronic osteomyelitis?
ulceration of the skin (this may result in sinus tract formation)
This may be one cause of endogenous osteomyelitis.
urinary tract infection, long-term IV catheter, hemodialysis, IV drug abuser, salmonella infections of the GI tract
When does compartment syndrome occur?
usually develops within 48 hours of an injury, irreversible effects can start as early as 4 hours!!!!
fat emboli occurs when?
usually occurs 12-48 hrs after injury, but can be delayed up to 3 days following the injury
This is the most common complication of lower extremity surgery or trauma and the most often fatal complication of musculoskeletal surgery.
venous thromboembolism (VTE)
Management of hypocalcemia
• Administer calcium gluconate or calcium chloride • May need to give magnesium with calcium • Dietary changes • Vitamin D supplement • Monitor cardiac rhythm • Monitor neuromuscular symptoms →seizure precautions! • Monitor respiratory and airways status: Tracheostomy tray at bedside in case of severe laryngospasm Assess diet for adequate intake of calcium, Vitamin D and protein
Hypermagnesemia managment
• Check for med orders that contain Mg • IV fluids • Diuretics (if no renal failure) • If severe: Calcium gluconate (to counter cardiac effects) • May need mechanical ventilation • Monitor cardiac rhythm • Monitor neuromuscular system
What is the name for nearsightedness?
Myopia
This disorder is related to an excess of endolymphatic fluid which causes vertigo and tinnitus.
Ménière's disease
What are neurovascular checks?
Neurovascular checks-- assessment of blood flow and sensation to areas of the body, usually the extremities.
What are NSAID's? Give an example of an NSAID
Non-steroidal anti-inflammatory drugs Ibuprofen (e.g. brand names Advil, Motrin, Nuprin) Naproxen (e.g. brand names Aleve, Naprosyn) COX-2 inhibitors (e.g. brand name Celebrex) Aspirin
What is the name of the device that is used to examine the retina?
Ophthalmoscope
This is the medical name for the "blind spot"
Optic disk, it contains only nerve fibers and NO photoreceptor cells
This disorder is caused when abnormal bone forms on the stapes and affects hearing.
Otosclerosis
1 Unit of packed red blood cells
PRBCs, most commonly used blood component -one unit of PRBC is approx. 350 mL in volume, of which RBC volume is 200-250 mL
Dysuria
Pain or burning with urination
What's so bad about sugar in our patients?
Patients spend 1-3 days longer in hospital Increased neuron damage Increased platelet aggregation and thrombosis Insulin decreases levels of free fatty acids Increased cytokine levels and inflammation Impaired functioning of neutrophils • Increased Infections!!!!
This type of pain is a frequent complication of amputation.
Phantom limb pain
This is the medical name for bright flashes of light.
Photopsia
Age related changes when near objects such as reading material must be placed farther from the eye to be seen clearly is known as this
Presbyopia
Pyuria
Presence of 3 or more WBC's
Acute Pain
Priority nursing diagnosis for the patient with pyelonephritis
Cystocele
Prolapse of the bladder into the vagina
Patients should be placed in this position every 3-4 hours to prevent hip flexion contractures.
Prone position
This the medical term for drooping of the eyelid.
Ptosis
This is the name of the opening where tears drain
Punctum
This happens to the pupil with miosis
Pupillary constriction
This happens to the pupil with mydriasis
Pupillary dilation
Hematuria
RBC's in the urine
RIGHT SIDE STROKE
RIGHT HEMISPHERE Left hemiplegia Left visual field deficits Spatial-perceptual deficits Denies or is unaware of deficits Easily distracted Poor judgment impulsive
This is the term for bending light rays from the outside world into the eye
Refraction
Chronic Complications of Diabetes
Related to blood vessel disease Micro vascular Disease: eyes, kidneys, nerves Macro vascular Disease Atherosclerosis heart disease, strokes, claudication
Urge Urinary Continence
Related to decreased bladder capacity, bladder spasms, diet, and neurologic impairment-also known as overactive bladder
Function Urinary Incontinence
Related to impaired cognition such as dementia
Stress Urinary Incontinence
Related to weak pelvic muscles and structural support-occurs with sneezing, jogging, lifting
RICE
Rest Ice Compression Elevation
With this disorder the patient may describe the sensation of a curtain being pulled over part of the visual field.
Retinal detachment
What are the names of the 2 types of photoreceptors and which one works at low light and provides peripheral vision and which one works at bright light and provides color and central vision?
Rods and cones -rods work at low light levels and provide peripheral vision -cones work at bright light and provide color and central vision
The tubes in the ears that are filled with fluid and help maintain a sense of balance
Semicircular canals
Damage to the 8th cranial nerve can cause this type of hearing loss.
Sensorineural
Hypocalcemia
Serum calcium level below 8.9mg/dl or an ionized calcium level below 4.5mg/dl) Manifestations • Mainly neuromuscular irritability • Paresthesias of the toes, fingers, face(numbness tingling ) • Muscle cramps(calf or foot ), tremors • Laryngeal and abdominal muscles are prone to spasm: abdominal cramping, diarrhea, laryngospasm Trousseau's sign · Chvostek's sign · Mental status changes: Anxiety, confusion, depression, memory impaired, delusions, hallucinations · Decreased cardiac output, decreased B/P · Dysrhythmias
The nurse is assessing the casted extremity of a client. Which sign is indicative of infection?
Signs of infection under a casted area include odor or purulent drainage from the cast or the presence of "hot spots," which are areas of the cast that are warmer than others. The health care provider should be notified if any of these occur. Signs of impaired circulation in the distal limb include coolness and pallor of the skin, diminished distal pulse, and edema.
What is the official name of the eye chart?
Snellen Chart
Urosepsis
Spread of infection from urinary tract to bloodstream
Kegel exercises
Strengths the muscles of the pelvic floor
A hordeolum is the medical term for this...
Stye
When instructing D.M. to use crutches, his weight should rest on what part of his body while the crutch is bearing the weight? Explain why.
Support body with hands and arms—don't want patient resting on axilla due to radial nerve which if injured could cause paralysis of wrist and elbow extensors ( commonly called crutch palsy)
What is the only cure for cataracts?
Surgery
These structures are located in the middle ear
The eardrum and the 3 bony ossicles (incus, malleus, stapes)
The nurse has conducted teaching with a client in an arm cast about the signs and symptoms of compartment syndrome. The nurse determines that the client understands the information if the client states that he or she should report which early symptom of compartment syndrome?
The earliest symptom of compartment syndrome is paresthesia (numbness and tingling in the fingers). Other symptoms include pain unrelieved by opioids, pain that increases with limb elevation, and pallor and coolness to the distal limb. Cyanosis is a late sign. Pain that is out of proportion to the severity of the fracture, along with other symptoms associated with the pain, is not an early manifestation.
What is the colored portion of the external eye?
The iris
Escherichia Coli
The most common pyelonephritis-causing organism