Nursing 103 Chapter 53 & 54 Study Guide
Which question is likely to elicit the most valid response from the patient who is being interviewed about a neurologic problem?
"Can you describe the sensations you are having?"
Sjogren's:
"dry eye" appears after eye surgery. There is insufficient production of tears. Excessive use of antihistamines, antidepressants, and decongestants may cause this to appear. S/S: grittiness of the eye, blurred vision, reddened eyes with a stringy mucus.
What are the most common symptoms of macular degeneration?
(1) a gradual loss of ability to see objects clearly; (2) distorted vision, with objects appearing to be the wrong size or shape or straight lines appearing wavy or crooked; (3) gradual loss of clear color vision; (4) scotomas (blind spots in the visual field); and (5) a dark or empty area appearing in the center of vision.
What Glasgow Coma Scale rating would a patient receive who opens the eyes spontaneously, but has incomprehensible speech and obeys commands for movement?
12
The nurse is aware that the pt has 20/40 vision. This means that the pt can see at 20 feet what the normal eye can see at ______ feet.
200
Calculation:
Ask a simple math question
Orientation:
Ask questions to determine the patient's orientation to person, place, time, and purpose.
Fund of knowledge:
Ask the patient to name the president and to tell you what's on the national news.
Memory:
Assess short-term memory; do not ask yes or no questions.
Why would a pt use an Amsler grid? What should they report to their physician?
A diagnostic tool for retinal disorders, it requires the pt look at the dot on the grid and report any distortion in the grid lines.
Anomic aphasia:
A form of aphasia characterized by the inability to name objects.
Goldmann tonometry:
A more invasive study; The eye is numbed and a cone-shaped device is used to depress the eyeball gently to assess for internal pressure.
Amsler grid:
Assesses for disturbances in central vision. It is used to evaluate the health of the macula, identifying conditions such as macular degeneration. Black markings are super imposed on a white background. A centralized black dot is used as the point of reference. The patient is asked to view the grid, concentrating on the dot, and report areas of distortion.
FOUR coma scale:
Assesses the pt in four categories- eye response, brainstem reflex. Motor responses and respirations. The scores are reported as individual scores in each category. It is frequently done in conjunction with the Glasgow coma scale, not part of it.
What is photocoagulation and how is it useful?
It is a nonsurgical procedure usually performed on an outpatient basis. A small, intense beam of light is directed into a small spot on the retina. The light converts heat to energy, and coagulation of the tissue protein occurs. The structures of the eye remains undisturbed and only the sealing of leaks and destruction of offending tissue occur. The procedure is used to manage conditions such as ARMD and diabetic retinopathy to cauterize hemorrhaging vessels. It cannot increase visual acuity but can prevent further loss. Usually no hospitalization or postoperative medical management is required.
Sensorineural hearing loss:
It produces lateralization of sound to the better ear in the Weber test.
Which of the following are causes of cataracts? SATA:
Long-term use of corticosteroids; Congenital exposure to maternal rubella; Diabetes mellitus; Smoking
What are the effects of normal aging on the nervous system? (Select all that apply.)
Loss of neurons; Reduction of cerebral blood flow; Lipofuscin; Decrease in oxygen use
The newly admitted patient to the emergency room 30 minutes ago after a fall off a ladder has gradually decreased in consciousness and has slowly reacting pupils, a widening pulse pressure, and verbal responses that are slow and unintelligible. What is the most appropriate position for the patient?
Neck placed in a neutral position
_________________ is/are responsible for the transmission of impulses between synapses.
Neurotransmitters
Total blindness:
No light perception and no usable vision
Effects of aging on the body:
Normal age-related changes occur such as loss of neurons, reduction of cerebral blood flow, appearance of lipofuscin, a decrease in oxygen use and brain metabolism, and a decline in velocity of nerve impulses.
Nursing interventions/patient teaching for a stroke patient regarding safe swallowing:
Nurse may add thickening to the foods or liquid; Have the pt sit up at a 90 degree angle with the head up and the chin slightly tucked when swallowing. Techniques necessary for safely feeding a hemiplegic pt: check affected side of mouth for food accumulation; Offer small bites of food- adding a thickening agent to liquids.
A patient, age 45, is to have a myelogram to confirm the presence of a herniated intervertebral disk. Which nursing action should be planned with respect to this diagnostic test?
Obtain an allergy history before the test.
Central hearing loss:
Occurs when the brain's auditory pathways are damaged, as in a stroke or tumor.
Transient Ischemic Attack (TIA):
Refers to an episode of cerebrovascular insufficiency with temporary episodes of neurologic dysfunction lasting less than 24 hrs and often less than 15 min. Most resolve within 3 hrs. TIA are considered a forerunner of a stroke.
Enucleation:
Surgical removal of the eyeball; Often necessary after eye trauma & sometimes due to malignant tumor; NI: •Aid pt in expressing feelings •Applying dressing over eye socket to control hemorrhage •Treat pain •Provide pt teaching about how to remove, cleanse, & replace prosthesis
Proprioception:
The body's sense, based on internal stimuli, of its own position and limb movements. Unable to discern the position without looking at it.
Causes of Labyrinthitis:
Viral upper respiratory tract infection that spreads to the inner ear; Certain drugs & foods; May be destroyed by Streptomycin; Tobacco & alcohol; Bacteria (Rare)
What are Intacs and how are they used?
Intracorneal implants, known as Intacs, are microthin rings implanted through incisions in the side of the cornea. The corneal rings reshape the curvature of the cornea to improve visual acuity. Intacs are used for the patient who has keratoconus, a progressive disease in which the cornea thins.
Automated perimetry test:
Places the patient in front of a computer-like device and asks him or her to stare at a screen and to press a button when flashes of light enter the field of vision.
What must a pt do follow a left vitrectomy?
Position self in a face-down position for 4 to 5 days
A family member of a patient who has just suffered a tonic-clonic seizure is concerned about the patient's deep sleep. What is this behavior called?
Postictal period
Snellen test:
The most common eye exam. It assesses visual acuity. The patient is placed 20 feet from the chart and asked to read lines. The degree of vision is evaluated and the patient's acuity is assigned. Vision said to be 20/20 indicates that the individual has normal vision and can read at 20 feet the prescribed line. Vision identified as 20/40 indicates that the patient can read at 40 feet what the normal eye can see at 20 feet. The chart is modified for children by using shapes or pictures.
The pt tells the nurse that he is legally blind. How would this information impact the nurse's plan of care for this pt?
The nurse would need to determine how this pt's visual impairment affects normal functioning
Myringotomy:
The opening of the eardrum with a specialized knife or a heated wire loop to relieve pressure in the middle ear
Early stage of Alzheimer's disease:
The person has relatively mild memory lapses and may have difficulty using the correct word. The attention span is decreased, and there may be disinterest in surroundings. Depression may occur at this time
How would the nurse explain the purpose of photocoagulation to a diabetic pt with diabetic retinopathy?
The procedure will destroy new blood vessels, seal leaking vessels, and help prevent retinal edema.
A patient has recently suffered a stroke with left-sided weakness and has problems with choking, especially when drinking thin liquids. What nursing interventions would be most helpful in assisting this patient to swallow safely?
Tuck chin when swallowing
What would a nurse do when the pt arrives in the PACU after a left stapedectomy? SATA:
Turn the pt to his right side; Leave the bed flat; Medicate immediately on the complaint of nausea
Miotic eye drops:
Used for a pt with cataracts, they constrict the pupil and open the canal of Schlemm.
What is the cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and also carries motor fibers to glands that produce digestive juices and other secretions?
Vagus nerve
Congenital hearing loss:
Present from birth or early infancy. It can caused by anoxic injury (brain injury resulting from oxygen deprivation) or trauma during delivery, Rh factor incompatibility, or the mother's exposure during pregnancy to syphilis or rubella, or the use of ototoxic drugs.
Functional blindness:
Present when the pt has some light perception but no usable vision; may be congenital or applied
Why are the drugs neostigmine (Prostigmin) and pyridostigmine (Mestinon) helpful to the person with myasthenia gravis?
Promotes nerve impulse transmission
As the result of a stroke, a patient has difficulty discerning the position of his body without looking at it. In the nurse's documentation, which would best describe the patient's inability to assess spatial position of his body?
Proprioception
Four basic processes necessary to form an image?
Refraction, Accommodation, Constriction, & Convergence
Ischemic stroke:
Results from deficient blood flow to the brain from a partial or complete occlusion of an artery. They are either thrombotic or embolic.
Terminal stage of Alzheimer's disease:
Severe mental and physical deterioration is present. Total incontinence is common.
The nurse is aware that the characteristic gait of the person with Parkinson disease is a propulsive gait, which causes the patient to:
Shuffle with arms flexed
What is the nurse aware of when assessing a person with a craniocerebral injury?
Signs and symptoms may not occur until several days after the trauma
A patient with a spinal cord injury at T1 complains of stuffiness of the nose and a headache. The nurse notes a flushing of the neck and "goose flesh." What should be the primary nursing intervention based on these assessments?
Sit upright and check blood pressure
What is the basic problem that prompts most of the early signs of Alzheimer disease?
Memory loss that disrupts daily life
Phacoemulsification:
Most common type of extracapsular cataract extraction; Uses an ultrasound to break up & remove the cataract through a small incision; NI & PT teaching: Aimed at postop care (If no complications, pt goes home in a few hrs)
The nurse is aware that the drug t-PA (Activase), a tissue plasminogen activator, must be given in____hours of the onset of symptoms to have maximum benefit
3 hours
Parkinson's disease:
A syndrome that consists of a slowing down in the initiation & execution of movement (bradykinesia), increased muscle tone (rigidity), tremor, & impaired postural reflexes. TRIAD sign- is tremor, rigidity, and bradykinesia. S/S- Tremor, rigidity, bradykinesia and impaired postural reflexes, shuffled gait with arms flexed. Treatment: is based on easing the s/s of the disease; hospitalization may be required for a "drug holiday" to restart drugs at a lower dosage with favorable results. Surgery can be performed - DBS deep brain stimulation. NI- To assist the pt with PD in approving his/her activity level instruct them to walk with hands clasped behind beck to help with balance, do not hurry them, if they "freeze" tell them to consciously think about stepping over imaginary or actual lines; nutrition is essential to prevent malnourishment and constipation. PT Teaching- Educate pt on the disease, including importance of taking prescribed meds; stress the need for good skin care and keeping active; demonstrate proper ambulation and positioning; teach proper feeding techniques to prevent aspiration.
Agnosia:
A total or partial loss of the ability to recognize familiar objects or people. (pt may eat with napkin instead of fork)
The nurse is aware that when assessing a patient by the FOUR score coma scale, the patient is assessed in four categories: eye response, brainstem reflexes, motor response, and respiration. How are these results reported?
As individual scores in each category
What medications are often used to treat patients with neuropathic pain?
Anticonvulsants such as gabapentin (Neurotin) and carbamazepine (Tegretol); Other medications include nonopioid analgesics such as acetaminophen, nonsteroidal anti-inflammatory drugs, and acetylsalicylic acid. Opioids do not appear as helpful, although sometimes they are used; Antidepressants such as amitriptyline, doxepin, imipramine, and nortriptyline (Pamelor).
Entropion:
Abnormal turning of the eyelid causing irritation and tearing of the eye.
What is the process when the lens of the eye changes its curvature to focus on the retina?
Accommodation
What is multiple sclerosis (MS) and how is it treated?
Achronic, progressive, degenerative neurologic disease that affects many people. The cause is unknown, although genetics have be implicated, because there is a higher rate of disease among relatives; No specific treatment exists, although many different remedies have been tried. Symptoms are controlled with the use of adrenocorticotropic hormone (ACTH) and corticosteroids such as prednisone (Deltasone) or dexamethasone. these may be given orally, IM, or IV; If spasticity is a problem, drugs such as diazepam, dantrolene, and baclofen may help prevent or decrease the spasms. Immunomodulating drugs modify the disease process. Interferon beta-1b (Betaseron), given subq every other day, is indicated for use in ambulatory patients with relapsing-remitting MS to reduce the frequency of clinical exacerbations. Interferon beta-1a (Avonex) is similar to interferon beta-1b in efficacy and is used in similar patient groups with MS. It is given IM once a week. Another formulation of interferon beta-1a, Rebif, is administered subq three times weekly. Glatiramer acetate (Copaxone) is used in relapsing-remitting MS. It is given subq daily. Mitoxantrone is a drug for the treatment of primary-aggressive and progressive-relapsing MS. It is an immunosuppressant drug that reduces B and T lmphocytes. It is given IV monthly.
How would a nurse record the behavior when a patient with Alzheimer disease attempts to eat using a napkin rather than a fork?
Agnosia
When the newly blind male home health pt asks the nurse how he might get assistance, who might the nurse suggest he contact?
American Foundation for the Blind for a list of agencies
Guillian-Barre Syndrome (GBS):
An acute, rapidly progressing, and potentially fatal form of polyneuritis. It results in widespread inflammation and demyelination of the peripheral nervous system. It is diagnosed by elimination of other reasons for the s/s and by the characteristic muscle weakness. The pt is hospitalized immediately due to the fact the disease can rapidly progress into respiratory failure.
What is Labyrinthitis (inner ear problems)?
An inflammation of the labyrinthine canal of the inner ear. Most common cause of vertigo.
When the pt stares at the black dot on an Amsler grid, what should the nurse ask him to report?
Any distortion of the grid
A pt who had an encluceation of the right eye has been admitted PACU. What should the nurse include in the plan of care?
Apply a pressure dressing over the right eye socket
What does the cataract treatment of phacoemulsification involve?
Breaking the cataract with ultrasound
Select all the conditions that may cause conductive hearing loss:
Buildup of cerumen; Foreign bodies; Otosclerosis of external auditory canal; Otitis media with effusion
What does the nurse know about the stroke patient who has expressive aphasia?
Can understand the spoken word, but cannot speak
What does diabetes retinopathy result from?
Capillaries in retina hemorrhage
Cataracts:
Causes: long-term use of corticosteroids, DM, smoking, congenital from exposure to maternal rubella. Early s/s: difficulty driving at night and blurred vision. Pt teachings after repair - avoid lifting heavy objects. NI: Advise pt to wear pear dark protective lens when using UV light, the lamp can cause cataracts.
What are the two divisions of the nervous system?
Central and the peripheral
Which of the following techniques are necessary for safely feeding a hemiplegic patient? (Select all that apply.)
Checking the affected side of mouth for food accumulation; Offering small bites of food; Adding a thickening agent to liquids
Mixed hearing loss:
Combined conductive and sensorineural hearing loss
What are surgical navigational systems?
Computerized devices that guide the surgeon
What is the reticular activating system (RAS) essential to? (Select all that apply.)
Concentration; Wakefulness; Attention; Introspection
What does a tympanoplasty correct?
Conductive hearing loss
What are the types of hearing loss?
Conductive, sensorineural, mixed, congenital, functional, & central hearing loss
What do miotic eyedrops do for a pt with glaucoma?
Constrict the pupil and open the canal of the Schlemm
How to complete an in-depth neuro assessment:
During a level of conscious assessment, you ask pt who is the president or ask about current events this is Fund of knowledge. (Are they oriented to time, place, situation, self?)
What factors must the nurse consider when assessing readiness to learn when teaching health promotion practices for the visually and hearing impaired? SATA:
Cultural beliefs; Values; Habits
The nurse counsels the 16-year-old boy that playing his music at high volume can result in impairment in hearing related to:
Damage of the fine hair cells in the organ of Corti.
What is the cardinal sign of increased intracranial pressure in a brain injured patient?
Decrease in the level of consciousness
What is the cardinal sign of intracranial pressure?
Decreased LOC
What should the nurse do when assisting a blind person to walk in an unfamiliar hospital environment? SATA:
Describe the surroundings; Encourage the pt to ask for verbal cues; Place pt hand on nurse's shoulder or elbow
When the pt in the emergency room complains of seeing flashing lights and a curtain down over his right eye, the nurse recognizes this as a symptom of which condition?
Detached retina
Which complaint made by a 64-year-old pt during a health interview would alert the nurse to the possibility of cataracts?
Difficulty in driving at night
Mydriatic eye drops:
Dilating drops used to evaluate Internal surfaces and will cause photosensitivity for few hrs after exam.
Tonometry:
Done most commonly by puffing air onto the surface of the open eye. The eye pressure is measured by evaluating how the light reflections change as the air hits the eye.
What should the nurse include in the plan of care following a tympanoplasty?
Elevating head of bed with operative side facing upward
Embolic stroke:
Embolism is the second most common cause of a stroke. Usually occurs in younger generation.
The home health pt complains of tearing and a feeling of dryness in the right eye. The nurse assesses that the eyelid is turned inward and the sclera is red. The nurse documents the presence of a(n) ______.
Entropion
The total remove of an eye is a(n):
Enucleation
Which may contribute to otitis media? SATA:
Exposure to cigarette smoke; Allergies; Upper respiratory infections
The nurse will assess for ______ when the older adult home health pt complains that the entire right side of his head hurts and he cannot chew without pain.
External otitis
Sensory aphasia:
Inability to comprehend the spoken word
Motor aphasia:
Inability to speak or write, using symbols of speech
Global aphasia:
Inability to understand the spoken word or to speak
What is the first sign of Bell's palsy?
Inability to wrinkle forehead and pucker lips on affected side
Open-angled glaucoma (primary open-angled glaucoma):
Outflow of aqueous humor is decreased. Basically, the drainage channels become occluded. It is slowly progressive, results from degenerative changes. S/S: None during early stage, as progresses symptoms become apparent. Including loss of peripheral vision (tunnel vision); eye pain difficulty to adjusting to darkness; halos around light and inability to detect colors. NI: Assess eye pain and what time of day it occurs; assess frequency, intensity and duration of pain; Note S/S; note if IOP is present.
What is a common mistake that hinders communication when communicating with the hearing impaired?
Overaccentuating words
What are the major signs and symptoms of Parkinson disease?
Parkinsonism is a syndrome that consists of a slowing down in the initiation and execution of movement (bradykinesia), increased muscle tone (rigidity), tremor, and impaired postural reflexes.
What should the nurse do when the child arrives on the floor with the diagnosis of bacterial meningitis?
Place the child in respiratory isolation
Virectomy:
Removal of excess vitreous fluid caused by hemorrhage & replacement of normal saline; Postop management: prescription topical eye meds for 4-6 wks; Dark glasses prescribed; Assess eye patch; Applying cold packs; Monitoring vital signs, esp for fever; & assessing dressing for bleeding NI/Pt teaching: Pt is required to maintain a position on the abdomen or sitting forward, resting the nonoperative side of the head on a table to allow air that is in the eye to float against the retina; Position maintained 4-5 days
The nurse clarifies that the difference between a photorefractive keratectomy (PRK) and a laser in-situ keratomileusis (LASIK) is that a LASIK:
Removes some internal layers of the cornea
Migraine headaches:
The exact mechanism is unknown. S/S- Pt's often report experiencing an aura (prodromal signs that occur before the headache); Nausea, vomiting, sensitivity to light, chilliness, fatigue, irritability, diaphoresis, edema, and other signs of autonomic dysfunction. NI- Advise pt that certain foods like aged cheese (swiss and cheddar), cured meats, fermented cabbage (sauerkraut), soy and fish sauces, bologna, ham, hot dogs and bacon, vinegar, chocolate, yogurt, alcohol, marinated foods, and caffeine may all provoke a headache; help pt with relaxation techniques; planned sleeping hours; and regular rest periods. PT teaching- teach pt factors that trigger headache; teach them meds to be used; maintenance of sleep patterns.
Accommodation:
The eye can focus on objects at various distances. It focuses the images of an object on the retina by changing the curvature of the lens.
Refraction:
The eye is able to bend light rays so that the rays fall onto the retina.
Why would the nurse encourage a group of teenagers to protect their eyes with dark sunglasses while using a UV lamp?
The lamp can cause cataracts
Stapedectomy:
The removal of the stapes of the middle ear and insertion of a graft and prosthesis, performed to restore hearing in the cases of otosclerosis. The stapes that has become fixed is replaced so that the vibrations can again transmit sound waves through the oval window to the fluid of the inner ear. Using a local anesthetic and an operating microscope for visualization, the surgeon removes the stapes and covers the opening into the inner ear with a graft of body tissue. One end of a small plastic tube or piece of stainless steel wire is attached to the graft., while the other end is attached to the two remaining bones of the middle ear, the malleus, and the incus. Postoperative management consists of external ear packing to ensure healing; the packing is left in place for 5 or 6 days. Depending on the health care provider's preference, the patient remains in bed for approximately 24 hours and resumes activity gradually.
Constriction:
The size of the pupil, which is controlled by the dilator and constrictor muscles of the iris, regulates the amount of light entering the eye.
Which symptom is specific to migraine headaches?
They are preceded by an aura
Thrombotic stroke:
Thrombosis is the most common cause of stroke, and the most common cause of cerebral thrombosis atherosclerosis. Symptoms from this type of stroke tend to occur at night or soon after rising.
How would the nurse instruct a patient with Parkinson disease to improve activity level?
To walk with hands clasped behind back to help balance
The nurse explains that the triad of signs of Parkinson disease is: _______, _______, and _______.
Tremor, rigidity, and bradykinesia
What are the tests that are used to diagnosis retinal detachment?
Visual acuity measurements should be the first diagnostic procedure with any complaint of vision loss. Indirect and direct opthalmoscopy are used to detect pallor of the retina and detachment. The gonioscopy is used to provide a view of the anterior chamber of the eye. It provides a magnified view of any retinal lesions. Ultrasound may be useful to identify a retinal detachment if the retina cannot be visualized directly. (e.g, when the cornea, lens, or vitreous humor is hazy or opaque).
What are the three signs of Cushing response? (Select all that apply.)
Widened pulse pressure; Bradycardia; Increased systolic blood pressure
Which foods should the person who suffers from migraine headaches avoid? (Select all that apply.)
Yogurt; Caffeine; Marinated foods
The surgical incision into the eardrum with either a knife or a heated wire loops to relieve pressure in the middle ear is a(n):
Myringotomy
The nurse assures an anxious family member of a 92-year-old patient who is demonstrating signs of dementia that many causes of dementia are reversible and preventable. What is one example?
Hypotension
Proper care techniques for hearing aides:
If pt hears a whistling sound have them reinsert the hearing aid into the ear mold.
Legal blindness:
Individuals with a maximum visual acuity of 20/200 with corrective eyewear &/or visual field sight capacity reduced to 20 degrees (the normal visual field range is 180 degrees)
Four hours after a stapedectomy, the pt complains that hearing has not improved at all. What knowledge would the nurse use to shape a response?
Hearing will not return until edema subsides
The nurse is caring for a home health patient who had a spinal cord injury at C5 three years ago. The nurse bases the plan of care on the knowledge that the patient will be able to:
Feed self with setup and adaptive equipment.
An 83-year-old patient has had a stroke. He is right-handed and has a history of hypertension and "little" strokes. He presents with right hemiplegia. To afford him the best visual field, the nurse should approach him:
From the left side.
What is the nurse assessing when asking the patient, "Who is the president of the United States?" during a level of consciousness assessment?
Fund of knowledge
The nurse explains that a pneumatic retinopexy is a repair of a retinal detachment using a bubble of ______ to put pressure on the damaged retina.
Gas
The newly admitted patient to the emergency room after a motorcycle accident has serosanguineous drainage coming from the nose. What is the most appropriate nursing response to this assessment?
Gently wipe nose with absorbent gauze
Functional hearing loss:
Has no organic cause. It also is known as psychogenic or nonorganic hearing loss. May be caused by an emotional or psychological factor
Third stage of Alzheimer's disease:
He or she has total disorientation to person, place, and time. Motor problems such as apraxia (an inability to carry out learned sequential movements on command, perform purposeful acts, or use objects properly), visual agnosia (inability to recognize objects by sight) and dysgraphia (difficulty communicating via writing) interfere with daily functions. Wandering is common.
Otitis media:
Is found more frequently in children 6-36 months because the eustachian tubes in children are shorter and straighter, which provides easier access of the organism from the nasopharynx to travel to the middle ear; Usually caused by an upper respiratory infection with gram-negative bacteria, such as proteus, klebsiella, and pseudomonas. Other contributing factors are allergies, exposure to cigarette smoke, mycoplasma, ad several viruses.
Stapendectomy:
Removal of the stapes of the middle ear & insertion of a graft & prosthesis; Performed to restore hearing in cases of otosclerosis; Postop management/NI & PT teaching: •External earing packing to ensure healing- left in place 5-6 days; •Remains in bed approx 24 hr & resumes activity gradually •Keep pt flat with operative side facing upward to maintain position of prosthesis & graft- make certain pt is not turned •Headache, nausea, vomiting, & dizziness are expected early as a result of stimulation of the labyrinth intraoperatively •Hearing does not improve until edema subsides •Packing is removed by health care provider
What is the purpose of a "drug holiday" in the treatment of Parkinson disease?
Restart drugs at a lower dosage with favorable results
Diabetic retinopathy:
Results from capillaries in retina hemorrhage or aneurysms.
The 62-year-old home health pt who is recovering from eye surgery complains of a feeling of "grittiness" in the eye and having blurred vision. The eyes are reddened and have stringy mucus. What do these complaints indicate?
Sjogren syndrome
Sensorineural hearing loss:
Sound is conducted through the external and middle ear in the normal way, but a defect in the inner ear results in its distortion, making discrimination difficult. Trauma, infectious processes, presbycusis, congenital conditions, and exposure to ototoxic drugs may cause this type of hearing loss. Destruction of the cochlear hair by intense noise also may cause it. amplifying sound with a hearing aid may help some people with this type of loss. However, many people have intolerance to loud noise and are not helped by a hearing aid.
The waxy substance that covers the neuron fibers and increases the rate of transmission of impulses is the ________.
myelin
A ___________ is a diagnostic procedure used to identify lesions by observing the flow of radiopaque dye through the subarachnoid space.
myelogram
Involuntary rhythmic movement of the eyes, with oscillations that may be horizontal, vertical, or mixed movements, is called ___________________.
nystagmus
What should the nurse remindd the hearing aid wear to do when the nurse hears a whistling hearing aid?
Reinsert the ear mold
Otosclerosis:
Is a progressive deafness caused by the ankylosis of the staples.
Which is a sign of acute angle closure glaucoma (AACG)?
Large fixed pupil
The nurse takes into consideration that the Weber test indicated a conductive hearing loss in a pt because the pt reported hearing the tone:
Louder in his affected ear
How are patients selected for refractory surgery?
Reshaping the corneal curvature, is effective in treating the underlying complications causing visual problems. Myopia is the refractive error most commonly corrected by laser surgery. Patients are selected on the basis of the degree of myopia; the shape of the cornea; and the absence of medical conditions such as severe diabetes, glaucoma or pregnancy. The usual age for correction is between 20 and 60 years.
Hemorrhagic stroke:
Results from bleeding into the brain tissue or subarachnoid space. The bleed causes damage by destroying and replacing brain tissue. An aneurysm is often the cause of hemorrhage.
A patient is in which stage of Alzheimer disease when she demonstrates "sundowning"?
Second stage
Progressive deafness caused by the ankylosis of the stapesis the condition of ______.
Otosclerosis
Pt teaching for a chemical splash in the eyes:
•Treated with a 20-minute or longer normal saline flush immediately after exposure; This helps to prevent scar formation & subsequent loss of vision •Separate the eyelids while flushing affected eye to ensure maximum irrigation •Crucial; Requires immediate and effective tx & examination by an ophthalmologist; •May be prescribed topical antimicrobial meds for chemical splash •If tx is interrupted, ineffective, or not sustained, permanent eye damage will occur •Most frequent complications include infection, vision disturbances, & blindness •Apply ointments & dressings if ordered •Use other therapy devices, such as warm or cool compresses as needed •Use proper handwashing techniques •Wear dark sunglasses if cycloplegic or mydriatic eyedrops are used •Avoid future exposures to chemical or environmental hazards •Important discharge instructions, including need for follow up visits, & symptoms to report
Seizures:
A result of abnormal electrical activity within the brain. S/S: Classified according to type of seizure. Followed by a rest period of variable length called the postictal period. During this time pt feels groggy, acts disorientated, complaints of muscle aches and headache is common. Pt may experience an aura - a sensation or emotion that may precede an attack of a migraine or an epileptic seizure. NI: Protect against aspiration and injury and observation and recording of the seizure activity; never leave pt alone; no objects can be placed in mouth; maintain the airway. PT teaching: inform pt after of seizure and reorient if necessary.
Why is otitis media found more frequently in children 6 to 36 months?
Eustachian tubes in children are shorter and straighter
One of the housekeepers splashes a chemical in the eyes. What should be the first priority?
Irrigate with normal saline solution for 20 minutes
A frantic family member is distressed about the flaccid paralysis of her son following a spinal cord injury several hours ago. What does the nurse know about this condition?
It is possibly a temporary condition and will clear.
Convergence:
Medial movement of both eyes allows light rays from an object to hit the same point on both retinas.
Following a myelogram the nurse should include in the postprocedure care assessment for:
Sensation in lower extremities
Photocoagulation:
Uses a laser beam to destroy new blood vessels, seal leaking vessels, & help prevent retinal edema.
Arrange the parts of the eye from the exterior to the most interior:
1. Cornea 2. Aqueous humor 3. Iris 4. Lens 5. Retina 6. Choroid
The nurse explains that the two divisions of the autonomic nervous system work to maintain homeostasis. Place in order the autonomic events. (Separate letters by a comma and space as follows: A, B, C, D):
1. Extremely stressful or frightening event 2. Sympathetic nervous system dominates 3. Heart rate and blood pressure rise, secretion of adrenaline 4. Parasympathetic nervous system dominates 5. Blood pressure, heart rate, and adrenaline output decrease
How are seizure disorders such as epilepsy treated?
In 70% of patients, seizure disorders are controlled by one or more anti-seizure drugs. Therapy is aimed at preventing seizures because cure is not possible. Drugs generally act by stabilizing nerve cell membranes and preventing spread of the epileptic discharge. The choice of medication depends on the type of seizure. Failure to take prescribed medication or an adequate dose is often the cause of treatment failure. Blood levels may be checked to determine the therapeutic levels of the medications taken. The primary goal of anti-seizure drug therapy is to obtain maximum seizure control with minimum toxic side effects. Pharmalogic therapies to control seizure activity are not possible for some patients with epilepsy. They may considered candidates for surgical intervention. Surgery to manage seizure activity may include removal of the small area of the brain that is experiencing the misfiring and causing the seizures. This is called resection. The connective tissue between the two hemispheres of the brain also may be severed in some cases.
Angiogram (cerebral arteriography):
Is a procedure used to visualize the cerebral arterial system by injecting radiopaque material. It allows detection of arterial aneurysms, vessel anomalies, ruptured vessels, and displacement of vessels by tumors or masses. Before the procedure the patient usually is given clear liquids, although in some institutions all oral intake is restricted; The test takes approximately 2 to 3 hours. The patient may become uncomfortable lying still for that length of time. When the dye is injected, most patients complain of feeling extremely hot, feeling flushed, and experiencing a metallic taste. The patient is positioned supine on the radiograph table. A local anesthetic is use to anesthetize the area of the puncture site. The catheter is introduced through the skin (percutaneously) and introduced into the relevant vessels. At times the catheter may be inserted directly into the carotid or vertebral arteries. After all injections are done, the catheter is withdrawn and pressure is applied to the puncture site for at least 15 minutes. After the procedure, bed rest is ordered, usually for 4 to 6 hours; The patient undergoing this procedure is at risk for cerebrovascular accident and increased ICP.
Tympanoplasty:
Is any of several operative procedures on the eardrum or ossicles of the middle ear to restore or improve hearing in patients with conductive hearing loss. These operations may be used to repair a perforated eardrum, for otosclerosis, or for dislocation or necrosis of a small bone of the middle ear. Postoperative management consists of rest until the next morning. Elevate the head of the bed 40 degrees, and keept the operative side facing upward. Medications include opioid analgesics, otic and oral antibiotics, and meclizine for vertigo.
Detached retina:
S/S: pt sees flashing lights and a curtain down over his eyes. Procedure is done to repair the retinal detachment a pneumatic retinopexy is performed, using a bubble of gas to put pressure on the damaged retina. NI: Admin prescribed eye drops; eye patched are applied over eyes to allow for rest for 1-2 days; safety measures are essential cuz the eyes are patched.
Bell's Palsy:
S/S: there is usually an abrupt onset of numbness, stiffness, or drawing sensation of the face. Unilateral weakness of the facial muscles usually occurs, resulting in flaccidity of the affected side of the face with inability to wrinkle forehead, pucker lips, close the eye lids, smile, frown, whistle, or retract the mouth on affected side.
S/S of Labyrinthitis:
Severe & sudden vertigo; Nausea & Vomiting; Nystagmus; Photophobia; Headache; & Ataxic gait
What should a pt who has had a cataract repair avoid?
The lifting of heavy objects
Myasthenia gravis:
is an autoimmune disease of the neuromuscular junction, characterized by fluctuating weakness of certain skeletal muscle groups. It is an unpredictable neuromuscular disease with lower motoneuron characteristics. It can occur at any age but most commonly between the ages of 10 and 65 years. Historically, the peak age of onset has been ages 20 to 30, but as the population has begun to age the age of onset is now after age 50. New studies have highlighted men being affected more than women; No observable structural change occurs in the muscle or nerve; Occurs in ocular and generalized terms; Subjective data include the patient's understanding of the disease, complaints of weakness or double vision, difficulty chewing or swallowing, and any bowel or bladder incontinence. Objective data include any documented muscle weakness on neurologic testing. Nasal-sounding speech may be noted; The voice often fades after a long conversation and breath sounds diminish. note ptosis of the eyelids and weight loss if there are swallowing problems; Because of the slow, insidious onset and occurrence of symptoms with stress, MG is sometimes misdiagnosed as hysteria or neurosis. The diagnosis can be made of the basis of history and physical examination; Medical management includes the use of anticholinesterase drugs such as neostigmine and pyridostigmine (Mestinon). The meds promote nerve impulse transmission and effectively alleviate symptoms. Corticosteroids may be used as an adjunct therapy. Immunosuppressive meds are used because of the the immune component; Many classes of drugs are contraindicated or must be used with caution. Plasmapheresis can yield short-term improvement in crisis or in preparation for surgery, when corticosteroids must be avoided. Thymectomy is indicated for almost all patients with a thymoma. ; Mg is a chronic dx. The course is variable with periods of exacerbation, and remission
What should the nurse advise the 20-year-old to do who has been put on cefaclor (Ceclor) for a resistant otitis media?
Avoid alcoholic beverages
What are the signs and symptoms of cataracts? Explain how they are treated:
Blurred vision, difficulty reading fine print, diplopia, photosensitivity, glare (the sense that normal light is too bright), abnormal color perception, and difficulty driving at night. ; Changing the patient's eyewear prescription can improve visual acuity; When palliative measures no longer provide an acceptable level of visual function, The patient is an appropriate candidate for surgery. Surgery is the only definitive method of treatment. There are two surgical methods to improve vision: Intracapsular extraction surgery involves removing the lens and its entire capsule. Although some surgeons still perform it (may be necessary in instances of trauma), this technique has been largely replaced by the extracapsular method. Extracapsular in which the anterior capsule is opened and the lens nucleus and cortex are removed, leaving the remaining capsular bag intact. Healing is rapid with this method. - Phacoemulsification is the most common type of extracapsular cataract extraction. This technique uses ultrasound to break up and remove the cataract through a small incision, thereby reducing the healing time and decreasing the chance of complications.
Myelogram:
Is commonly is used to identify lesions in the intradural or extradural compartments of the spinal canal by observing the flow of radiopaque dye through the subarachnoid space. The most common lesion for which this test is used is a herniated or protruding intervertebral disk; Water-soluable iodine dyes such as iopamidol (Isovue) commonly are used because they are absorbed by the kidneys. Preparation for this procedure is the same as for lumbar puncture; The patient usually is positioned on the side with both knees and the head flexed at an acute angle to allow maximal flexion of the lumbar area for ease in performing the lumbar puncture. After the puncture is performed, the inner stylet is removed to allow drainage of CSF, measurement of pressure, and collection of specimens. The patient then is turned to various positions so that the spinal cord can be visualized while flouroscopic and radiopaque films are taken. The patient usually undergoes a CT scan 4 to 6 hours after.
What is Guillain-Barré syndrome and what tests are used to diagnose this disorder?
It is an acute, rapidly progressing, and potentially fatal form of polyneuritis. It results in widespread inflammation and demyelination of the peripheral nervous system. ; It is diagnosed by elimination of other reasons for the S/S and by the characteristic muscle weakness. ACT scan may be ordered to rule out tumors or stroke. Changes in respiratory status may aid. A lumbar puncture is done. CSF in patient's with GBF commonly has elevated protein levels. The health care provider may order a nerve conduction velocity study to test for slow impulse transmission. Electromyography and nerve conduction studies are markedly abnormal. A history of a recent infection is considered important.
Lasix vs PRK
LASIK- A procedure in which first the cornea flap is folded back & then an excimer laser removes some of the internal layers of the cornea; Afterward, the flap is returned to it's normal position & allowed to heal in place; Evidence supports that it creates earlier visual stability in pt's with a high degree of myopia than PRK. It affects the central zone of the cornea. PRK- The use of an excimer laser to reshape the central corneal surface; Used primarily to correct myopia but is also used for hyperopia & astigmatism. Evidence suggests that final visual acuity with this procedure is more predictable than RK, at least in short term
Place the nursing intervention in appropriate order for the immediate care of a patient with a penetrating wound of the eye:
Lay the pt down flat; Assess eye, do not remove object; Check for the irregularity of the pupil; Cover both eyes with an eye shield or cup; Obtain medical attention immediately
How should the nurse advise a pt who has severe vertigo from labrynthitis?
Lie immobile and hold the head in one position until the vertigo lessens
Conductive hearing loss:
Long-term exposure to loud noises such as high-volume music (car or concert) can damage the fine hair cells in the organ of the corti. Causes: buildup of cerumen, foreign bodies, otosclerosis of external auditory canal, otitis media with effusion. During the Weber test conductive hearing loss produces lateralization of sound to the deaf ear. The pt will hear the tone louder in their affected ear.
Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig's Disease):
Loss of upper and lower motorneuorons. It is a rare, progressive neurologic dx that usually leads to death in 2 to 6 years, Also known as Lou Gehrig's dx. Onset is between 40 and 70 years, and two times as many men as women are affected. Primary symptoms are weakness of the upper extremities (hand are often affected first), dysarthria, and dysphagia. However, weakness may begin in the legs. Muscle wasting and fasciculations results from the denervation of the muscles and lack of stimulation and use. Death usually results from respiratory tract infection secondary to compromised respiratory function. There is no cure. A drug called riluzole (Rilutek) slows the progression. The drug helps protect motoneurons damaged by the dx and can add 3 months or more to a patient's life. The illness is devastating because the patient remains cognitively intact while wasting away.
Glasgow scale:
Measurement of LOC consists of three-part neurologic assessment: eye opening, motor, and verbal responses and combines the score together. Used in the critically ill, or predicting the duration and ultimate outcome of coma, particularly with head injuries.
When assessing level of consciousness, what four components of awareness are considered?
Orientation; Memory; Calculation; & Fund of knowledge
Tympanoplasty-
Repair of the tympanic membrane; Postop management/NI & PT teaching: •Bed rest until the next morning •Elevate head of the bed 40 degrees, & keep operative side facing upward •Meds include opioid analgesics, otic & oral antibiotics, & meclizine for vertigo •Monitor & report presence of bleeding; the amount, color, & consistency of the drainage; & temp; •Note complaints of vertigo when pt is getting out of bed •With sudden movements, nausea & vertigo may occur •Possible complications include- infection & displacement of the graft
Macular degeneration:
S/S: characterized by the slow loss of central vision and near vision. NI: Help pt through process of accepting loss of sight; maintain safety is essential.
Closed-angle glaucoma (Acute angle closure glaucoma):
S/S: eye pain, large fixed pupil with reddened sclera, decreased vision, nausea, and vomiting. NI: Assess eye pain and what time of day it occurs; assess frequency, intensity and duration of pain; Note S/S; note if IOP is present.
External otitis:
S/S: painful head, painful chewing, and pain when the auricle is moved, usually caused by compacted cerumen. Pt teaching: if pt is put on cefaclor for a resistant otitis media instruct pt to avoid alcoholic beverages, take it in its entirety, and store in the fridge, with no regards to meals.
Alzheimer's disease (AD):
Some forms of dementia are reversible and preventable. Dementia caused by hypotension, anemia, drug toxicity, metabolic disturbance, and malnutrition can all be corrected to abolish the dementia; Early sign of memory loss that disrupts daily life is a common problem that prompts pt is suffering from Alzheimer's Disease. Early stages- pt has relatively mild memory lapse and may have difficulty using the correct word. Attention span decreases, disinterested in surroundings and depression may set in. Second stage- pt has more obvious memory lapse, especially with short term memory and is usually disorientated to time. Loss of personal belongings is common as is confabulating (making up stories) to explain the loss of the memory. Ability to recognize family faces, places and objects and may get lost in familiar surrounding if wandering. Loss of impulse control and behavioral manifestations (e.g, agitation, repetitiveness, wandering, resisting care) occur. A specific type of agitation "sundowning", in which the pt becomes more confused & agitated in the late afternoon or evening. Behavior is neither intentional nor subject to self-control. Some pt's develop psychotic manifestations. (e.g, delusions, illusions, hallucinations). Third stage- he or she has total disorientation to person, place, and time. More problems such as apraxia (an inability to carry out learned sequential movements on command, perform purposeful acts, or use objects properly), visual agnosia (inability to recognize objects by sight), & dysgraphia (difficulty communicating via writing) interfere with the ability to carry out daily functions Wandering is common. Terminal stage- severe mental & physical deterioration is present. Total incontinence is common; These stages have some variations. All people with AD experience a steady deterioration in their physical & mental status, usually lasting 5 to 20 years until death occurs. NI: adequate nutrition; safety demands; most of the time education is directed at the family. Treatment: no effective treatment to stop the progression. We treat the S/S.
Conductive hearing loss:
Sound is inadequately conducted through the external or middle ear to the sensorineural apparatus of the inner ear. Common causes are build up of cerumen and otitis media with effusion. Other conditions that may result in conductive hearing loss are foreign bodies, otosclerosis, and stenosis of the external auditory canal. Sensitivity to sound is diminished, but clarity or interpretation of sound is not changed. Increased volume or amplification compensates for the conductive loss; therefore a hearing aid may be helpful
Communication techniques for the hearing impaired:
Speak in a normal tone, do not shout or raise the pitch of your voice. Common mistake is overaccentuating words. The nurse must consider contributing factors when providing pt teachings such as cultural beliefs, values, and habits, as well as the special needs of the older adult.
Aneurysm:
Surgery (craniotomy) may be necessary to prevent a rebleed; tPA - clot specific in its activation must be given within 3 hours of the onset of symptoms.
Vagus nerve:
The cranial nerve that supplies most of the organs in the thoracic and abdominal cavities and carries motor fibers to glands that produce digestive juices and other secretions.
Second stage of Alzheimer's disease:
The person has more obvious memory lapses, especially with short-term memory, and is usually disoriented to time. Loss of personal belongings is common, as is cofabulating (making up stories) to explain the loss of memory. Patients may lose their ability to recognize familiar faces, places, and objects and may get lost in a familiar environment. Loss of impulse control is common. Behavioral manifestations of AD (e.g, agitation, repetitiveness, wandering, resisting care) result from changes in the brain. A specific type of agitation is termed sundowning, in which the patient becomes more confused and agitated in the late afternoon or evening. The AD patient's behavior is neither intentional nor subject to self-control. Some patients develop psychotic manifestations (e.g, delusions, illusions, hallucinations)
Recommended nursing interventions for the pt with a headache:
•Help the patient with relaxation techniques, planned sleeping hours, and regular rest periods. •Teach the patient that alcohol should not be used to relieve tension because it may become addicting and has been found to be a significant cause of cluster headaches •Teach the patient that regular physical exercise also may help prevent headaches, especially those caused by tension •Plan interventions so that the patient has adequate time to rest (especially with severe headaches) •Other treatments that may help a patient with a headache include cold packs applied to the forehead or base of the skull and pressure applied to the temporal arteries. •People with migraine headaches are usually most comfortable lying in a dark, quiet room •Triggering factors associated with severe and recurring headaches may include fatigue, alcohol, stress, seasonal climate changes, hunger, allergies, and menstruation; help the patient identify these factors, if necessary, through ongoing observation or assessment of the patient's personality, habits, ADLs, career plans, work habits, family relationships, coping mechanisms, and relaxation activities. The patient may keep a diary or journal to help collect this information. •Teaching is an important part for the patient with headaches. Topics include: (1) avoidance of factors that trigger headaches; (2) relaxation techniques, including biofeedback; (3) maintenance of regular sleep patterns (4) medications to be used (including dosage, actions, and side effects); and (5) the importance of follow-up care
Refraction:
Refers to the bending of light rays as they enter the retina. An inability of the eye to accommodate the images seen is known as refractive errors. Refractive errors are diagnosed by asking the patient to sit with his or her chin rest on a supportive bar and looking into a device. The patient is then asked to read a chart 20 feet away, using a variety of lenses. As the lenses are changed, the patient is asked to evaluate the clarity of the information viewed. The result will determine the degree of visual acuity. Potential diagnoses of visual disorders include hyperopia, myopia, astigmatism, and presbyopia.•Visual field assessment: It is key in the evaluation of vision. There are six visual fields. The examination identifies the loss or deterioration of any field. Sitting straight in front of the patient, the examiner reviews the patient's ability to see items as they are moved into the field of vision.
Fluorescein angiography:
Retinal blood flow may be evaluated by dye that is injected into vessels of the arm or hand. This is an invasive procedure requiring the patient's consent. The patient should be instructed that urine could be darkened or possibly orange for a few days after the test. Uses iodine. Conditions that may be diagnosed by this test include retinal detachment, retinopathy, tumors, and macular degeneration.
Why is the patient with suspected Guillain-Barre Syndrome (GBS) hospitalized immediately?
The disease can rapidly progress into respiratory failure
What is the first indication of macular degeneration?
The loss of central vision
Slit lamp examination:
Uses magnification devices to view the eyelids, sclera, iris, conjunctiva, and cornea. It can also help evaluate intraocular pressure by tonometry to detect glaucoma. Dilating drops (mydriatics) may be used to evaluate internal surfaces and will cause photosensitvity for a hours after the examination. Conditions that may be diagnosed by this technique include cataracts, corneal injury, macular degeneration, and disorders of the retina, including detachment, vessel occlusion, and retinitis pigmentosa.
