Med surg 4

A nurse is preparing to perform a Weber test on a client. The nurse obtains which item needed to perform this test? a) a tongue blade b) a stethoscope c) a tuning fork d) a reflex hammer

*c)* a tuning fork --- A tuning fork is needed to perform the Weber test, during which the nurse places the vibrating tuning fork at the midline of the client's forehead or above the upper lip over the teeth. Normally, the sound is heard equally in both ears by bone conduction. If the client has a sensorineural hearing loss in one ear, the sound is heard in the other ear. If the client has a conductive hearing loss in one ear, the sound is heard in that ear.

Which symptoms are associated with acute closed-angle glaucoma? a) diplopia and photophobia b) episodic blindness and no pain c) blurred vision and colored rings around lights d) sensation of curtain drawn across the visual field

*c)* blurred vision and colored rings around lights

What is AACG?

- Acute Angle-closure glaucoma. - Occurs in people w/anatomically narrowed angle at junction where iris meets cornea. The angle is occluded which blocks aqueous fluid.

SATA: What are some communication blocks?

- Agreeing/disagreeing - Asking "Why" questions - Changing the subject - Giving advice - Giving apporval/disapproval - Giving false reassurances - Self-focusing behavior - Double-bind messages **Table 56.5 page 1364**

SATA: How is mental health defined?

- Be flexible, be successful - form close relationships - make appropriate judgments - solve problems - cope w/daily stress - have a positive sense of self

A MRSA pt needs to have their eyes irrigated. What steps would be included?

- Contact precautions = gloves, gown, and googles needed. - WASH hands before and after. - Apply anesthetic drops if ordered. Place basin beside side of head and towels. - APPLY gloves. - Assess pt's tolerance. - Document.

Describe what a stapedectomy is?

- Either part or all of the stapes is removed and replaced with a prosthesis. - Goal is to restore vibration from tympanic membrane to oval window and allow sound transmission. - Complications = extrusion of prosthesis, infection, hearing loss, dizziness, and facial nerve damage **Tx of choice for otosclerosis**

What is Meniere's Dz and what causes it?

- It is a balance disorder. There is dilation of the membranous labyrinth resulting from a disturbance in the fluid physiology of the endolymphatic system. - Cause is unknown. Usually develops between ages 40-60

You notice on your 72 yr old pt's chart that she has presbycusis. With this condition, you know what?

- It is the loss of hearing high pitched sounds like f, s, k, sh, g, and t. - When speaking to the pt, you need to use a lower pitched tone.

A pt is diagnosed w/bipolar disorder and is about to start lithium therapy. What should be included in the teaching concerning diet?

- Lithium is absorbed, distributed, and excreted alongside w/sodium. It is important to keep a normal balance of sodium intake. - Decreased sodium w/decreased fluids can lead to retention of lithium and cause toxicity. - Increased sodium w/increased fluids may hasten excretion resulting in worsening S&S of mania

How would you care for a pt post-op a otoplasty?

- Monitor for hemorrhage, hematoma, edema, and infection. - Ear dressing for 1 wk - teach pt to protect ear at time of sleep for 3 wks

What would be normal results and negative results of a cornea light reflex?

- Normal = light reflection should be exactly the same place on both pupils. - Negative = if they lack symmetry it could be a sign of muscle weakness

How do you care for a pt post-op a stapedectomy?

- Operative ear is positioned upward when lying in bed - can use an earplug to keep aseptic - administer antiemetics as ordered - provide a safe environment to prevent falls - instruct pt to no cough, sneeze, blow nose, vomit, fly, lift heavy objects, or shower. **If cold develops = notify DR**

What are the S&S of schizophrenia?

- Positive (excess or distortion of normal functioning) = hallucinations, delusions, disorganized thinking, and disorganized behavior. - Negative (Loss of normal functioning) = affective blunting or flattening, alogia, avolition, apathy, anhedonia, and social isolation

What is the corneal light reflex test?

Used to assess muscle balance. Shine a penlight toward the cornea while pt is staring at an object straight ahead.

Describe the Weber test.

Uses a tuning fork placed on center of pt's forehead or head. Checking to see if pt heard the noise and if they did hear it better in the left ear, right ear, or both.

What activities should the patient avoid so they do not have intraocular pressure after eye surgery?

Avoid vomiting, coughing, sneezing, straining, or bending

Which type of hearing loss will be most improved with a hearing aid?

Conductive hearing loss

Describe a mastoidectomy.

Involves incision, drainage, and surgical removal of the mastoid process if infection spreads to mastoid area

Which nationality has difficulty expressing emotions?

Irish

What is the Whisper test?

It checks hearing function in each ear. Pt occludes one ear with a finger and nurse stands 1-2 ft away on opposite side and whispers a 2 syllable word in towards the open ear.

What is an otoplasty and why would a person get an otoplasty?

It is an incision of the ear to correct a congenital defect, correct deformities, or improve cosmetic shape of ear.

How do you test visual fields by confrontation and what does it test?

It tests peripheral vision. **Page 1233 has the steps**

What is the Romberg test?

It tests vestibular function. Pt stands w/feet together w/opened eyes first then with them closed. -Normal = no difficulty maintaining a standing position w/minimal swaying -Positive Results =difficulty maintaining balance or loses balance which could be a sign of inner ear problem

What does PERRLA stand for?

Pupils equal, round, reactive to light, accomendation

A patient is using what they feel is a logical-sounding excuse to cover up what really is going on or happened. What is this called?

Rationalization

Describe what a myringoplasty is?

Reconstructive repair of a perforated tympanic membrane

A patient is unconsciously "burying" or forgetting events or appointments. What is this called?

Repression

A patient ask what does it mean when the doctor told him he has 20/60 vision. How do you explain?

That the patient can see at 20 ft what a normal eye sees at 60 ft.

What is cognitive ability?

The ability to think rationally and to process those thoughts

The following drugs maybe administered to the client with glaucoma EXCEPT: A.) Diamox (Acetazolamide) B.) Pilocarpine C.) Atropine SO4 D.) Timolol maleate

Atropine SO4 - Avoid anticholinergics and antihistamines like Benadryl they are mydriatics

A client with Meniere's disease is experiencing severe vertigo. Which instruction should the nurse give to the client to assist in controlling the vertigo? a) increase sodium in the diet b) avoid sudden head movements c) lie still and watch the television d) increase fluid intake to 3L a day

*B*- The nurse instructs the client to make slow head movements to prevent worsening of the vertigo. Dietary changes such as salt and fluid restrictions that reduce the amount of endolymphatic fluid are sometimes prescribed. Lying still and watching television will not control vertigo.

How to instill eye drops

*Box 51.4 page 1238*

12. The nurse notes that the physician has documented a diagnosis of presbycusis on the client's chart. The nurse plans care knowing that the condition is: a) tinnitus that occurs with aging b) nystagmus that occurs with aging c) a conductive hearing loss that occurs with aging d) a sensorineural hearing loss that occurs with aging

*D* --Presbycusis is a type of hearing loss that occurs with aging. Presbycusis is a gradual sensorineural loss caused by nerve degeneration in the inner ear or auditory nerve.

A nurse is providing diet instructions to a client with Meniere's disease who is being discharged from the hospital after admission for an acute attack. Which statement if made by the client indicates an understanding of the dietary measures to take to prevent further attacks? a) I need to drink at least 3 liters of fluid per day b) I need to restrict my carbohydrates intake c) I need to maintain a low-fat and low-cholesterol diet d) I need to be sure to consume foods that are low in sodium

*D* I need to be sure to consume foods that are low in sodium ----- sodium restricted diet is part of tx

How to teach prevention of ear problems.

*Table 51.8 pg 1247*

A clinic nurse is preparing to perform a Romberg test on a client being seen in the clinic. The nurse performs this test for the purpose of determining: a) the client's ability to ambulate b) the functional status of the vestibular apparatus in the inner ear c) the intactness of the retinal structure of the eye d) the intactness of the tympanic membrane

*b)* the functional status of the vestibular apparatus in the inner ear ----- The Romberg test assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance. The Romberg test also assesses intactness of the cerebellum and proprioceptio

What is schizophrenia?

- Serious disorder of thought and association and is characterized by the ability to distinguish between what is real and what is not and also by hallucinations, delusions, and limited socialization. - Four phases: Schizoid personality, Prodromal phase, Schizophrenia, and Residual phase - Causes debated on both sides of nature vs nurture (psychobiological vs psychoanalytical)

What are the S&S of Meniere's and how is it treated?

- Triad of symptoms: Vertigo, hearing loss, and tinnitus. - Tx: Tranquilizers and vagal blockers during acute attacks. Salt-restricted diet, diuretics, antihistamines, and vasodilators used prophylactically. Avoid alcohol, caffeine, and tobacco use.

What is conversion disorder?

- When there is a loss or change in physical functioning that seems to have a neurologic connection. - Two most common examples are paralysis and blindness

What is coping?

A way one adapts psychologically, physically, and behaviorally to a stressor.

What nationality has the highest risk of being misdiagnosed psychiatric disorder?

African Americans

What can cause cataracts?

Age, UV radiation (sunlight), diabetes, smoking, steroids, nutritional deficiencies, alcohol consumption, intraocular infections, trauma, and congenital defects

Describe what a myringotomy is?

An incision is made in the tympanic membrane and fluid is allowed to drain out or it is suctioned out of the middle ear

If extrapyramidal side effects like tardive dyskinesia occurs in a pt on antipsychotic meds, which class of medications might be administered?

Anticholinergics

While doing an assessment on a 53 year old pt, you notice an opaque whitening of the outer rim of the cornea in both eyes. What do you suspect this is called?

Arcus senilus

A nurse is caring for a client with acute otitis media. In order to reduce pressure and allow fluid to drain, the nurse anticipates that which of the following would most likely be recommended to the client? a) the administration of diphenhydramine (Benadryl) capsules b) a myringotomy c) strict bedrest d) a mastoidectomy

B. a myringotomy

A client is diagnosed with Meniere's disease. Which of the following nursing diagnosis should take priority for the client? A.)Altered body image B.) Risk for injury C.) Impaired social interaction D.) Ineffective coping

B.) Risk for injury

What are some adverse effects from eye medication toxicity?

Cardiac and respiratory issues can occur

A patient is unconsciously refusing to accept what his diagnosis is. What is this called?

Denial

What is psychoanalysis theory?

Developed by Freud. Consists of clarifying the meaning of events, feelings, and behavior and thereby gaining insight into them

You see in your pt's chart that they are experiencing otalgia. You know this means...

Ear pain

What part of the ear is the most common site for infections?

External ear

What med can cause hearing loss?

Furosemide (Lasix)

What is dissociative disorder?

Multiple personality disorder

What cranial nerve is used for sight?

II - Optic

A patient is blaming others for there problems. What is this called?

Projection (scapegoating)

What behaviors would cause a nurse concern when assessing a mental health pt?

Pt is always happy and smiling --- no one is 100% happy all the time

What is the most common and most effective treatment for alcoholism?

Support groups like AA that has a 12-step program

A pt tells you that it sounds like something is ringing and buzzing in his left ear. What do you suspect that he has going on?

Tinnitus

What cranial nerve is used for hearing?

VIII - Auditory

What type of behavior may aggravate a schizo pt?

Whispering or laughing when pt cant hear the whole convo. This can be interpreted as rejection or set off their paranoia