NCLEX - Adult Health (UWorld)

Cataract

A cataract is cloudiness (ie, opacity) of the lens that may occur at birth or more commonly in older adults. The signs/symptoms of a cataract include painless, gradual loss of visual acuity with blurry vision; scattered light on the lens producing glare and halos, which are worse at night; and decreased color perception.

Burn to the Eye

A chemical burn to the eye is an emergency. Alkali burns (concrete, drain cleaners containing lye) are particularly concerning as they will denude the protein and continue to penetrate until the substance is completely removed. Copious irrigation with water (at home) or normal saline/lactated Ringer's solution is started immediately. If the client cannot open the eye, another person should help open the eyelid. The irrigation should continue in the ambulance and in the emergency department with a special irrigating device that looks like a large contact lens. The pH of the eye is obtained prior to irrigation and irrigations continue until the eye pH is 7.0-7.5. Irrigation can last up to 60 minutes.

Meniere disease

(endolymphatic hydrops) results from excess fluid accumulation in the inner ear. Clients have episodic attacks of vertigo, tinnitus, hearing loss, and feelings of fullness or pressure in the ear. The disorder typically affects only one ear and can lead to permanent hearing loss. Attacks of Meniere disease can result in a total loss of proprioception, and clients often report feeling "pulled to the ground" (drop attacks), making client safety a priority. Vertigo can be severe and is associated with nausea, vomiting, and feelings of anxiety. Self-care for Meniere disease may include: Consuming a low-sodium diet to decrease the potential for fluid excess within the inner ear. Intake of potassium and other electrolytes does not need to be restricted. Limiting or avoiding aggravating substances (eg, nicotine, caffeine, alcohol) and stimuli (eg, flickering lights, watching television). Adhering to prescribed therapies for relief of symptoms (eg, antiemetics, antihistamines, sedatives, and mild diuretics) Avoiding sudden changes in the position of the head (eg, bending over) during vertigo spells Participating in vestibular rehabilitation therapy Implementing safety measures during attacks (eg, assistance with walking, bed rest)

Acute Adrenal Insufficiency/Adrenal Crisis

Etiology: adrenal hemorrhage or infarction. Acute illness/injury/surgery in patient with chronic adrenal insufficiency or long term glucoccorticoids use. Clinical features: hypo tension/shock, nausea, vomiting, abdominal pain, weakness, fever. Treatment: hydro-cortisone or dexamethasone, high flow IV fluids

Peritoneal dialysis (PD)

In peritoneal dialysis (PD), the abdominal lining (peritoneum) is used as a semipermeable membrane to dialyze clients with decreased kidney function. A catheter is placed in the peritoneal cavity for infusing and draining dialysate (dialysis fluid). Dialysate is infused and dwells in the abdomen, which allows waste products and electrolytes to cross the peritoneum into the dialysate for removal. After the prescribed dwell time, the dialysate, electrolytes, and wastes are drained via gravity. When administering PD, it is essential to use sterile technique when spiking and attaching bags of dialysate to the client's PD catheter to prevent contamination and infection. Bacterial peritonitis, an infection of the peritoneum, is a potential complication of PD that may lead to sepsis. Signs of peritonitis should be reported to the health care provider. Proper positioning of the catheter drainage bag (ie, below the abdomen) and the client (eg, Fowler or semi-Fowler position) promotes effluent outflow but is not a priority over infection prevention. Cloudy effluent may indicate infection, whereas bloody or brown effluent may indicate bowel perforation. Documenting effluent characteristics is important but not a priority over maintaining asepsis.

chronic obstructive pulmonary disease (COPD)

Many clients with chronic obstructive pulmonary disease (COPD) have a hypoxic drive to breathe. When supplemental oxygen is required, the nurse should select an oxygen delivery system that can be titrated to achieve peripheral oxygen saturation (Spo2) of 88%-92%. A Venturi mask, a high-flow device, is the best choice for clients with COPD and acute hypoxemia because the adapter allows precise control of the fraction of inspired oxygen (FiO2) that the client receives (up to 60%).

Dialysis Medication Administration

Medication administration may require modification on days that clients are scheduled to receive dialysis. The nurse should consider whether the medication will be dialyzed out of the client's system or may create adverse effects during dialysis. Fluid is removed during dialysis, which may cause hypotension. Typically, antihypertensives are held before dialysis to prevent hypotension. In addition, some medications are dialyzed out of the client's system and should therefore be held until after dialysis. Commonly held medications are water-soluble vitamins (eg, vitamins B and C), antibiotics, and digoxin.

Wound Healing

Nutritional deficiencies (eg, zinc, protein, vitamin C) and dehydration can impair wound healing. Dehydration (loss of free water) can increase serum sodium levels. The normal value for serum sodium is 135-145 mEq/L (135-145 mmol/L). Increased serum sodium level (hypernatremia) has an osmotic action that causes water to be pulled from the interstitial spaces into the vascular system. Remember that "water goes where salt is." This action decreases wound healing at a cellular level, reducing the nutrients cells need for repair. Normal blood urea nitrogen (BUN) values are 6-20 mg/dL (2.1-7.1 mmol/L). Elevated BUN may indicate dehydration and could impair wound healing. Malnutrition can impair wound healing. Serum albumin and prealbumin levels are obtained to assess nutritional status. The normal value for albumin is 3.5-5.0 g/dL (35-50 g/L). The normal value for serum potassium is 3.5-5.0 mEq/L (3.5-5.0 mmol/L).

Eye irrigation

Ocular chemical burns require immediate first aid and medical care to prevent permanent loss of vision. Eye irrigation with sterile saline or water should begin immediately (eg, eyewash station at the site of the incident) to flush the chemical irritant out of the eyes. Irrigation should be performed continuously until emergency personnel arrive and take over continuous eye irrigation during transport to an emergency care facility. Irrigation is continued until the pH in the eye returns to normal, typically 30-60 minutes, depending on the type of chemical.

Ocular trauma

Ocular trauma caused by a penetrating foreign body (eg, wooden splinter, metal filing) is a surgical emergency that requires urgent intervention to reduce the risk of permanent vision loss. Nurses providing first aid to clients with penetrating eye trauma must protect the eye from further injury. A shield, such as a paper cup, should be applied to prevent further trauma from movement of the foreign body. The unaffected eye is also covered because eyes move in unison, which could exacerbate trauma to the affected eye.

Overflow urinary incontinence

Overflow urinary incontinence occurs due to compression of the urethra (eg, uterine prolapse, prostate enlargement) or impairment of the bladder muscle (eg, spinal cord injury, diabetic neuropathy, anticholinergic medications). Both types involve incomplete bladder emptying and urinary retention, which lead to overdistension and overfilling of the bladder and frequent involuntary dribbling of urine. When caring for clients with overflow incontinence, the nurse should: Implement a fixed voiding schedule (eg, every 2 hours) to prevent bladder overfilling. Instruct the client to use the Valsalva maneuver (ie, "bearing down") and Credé maneuver (ie, gently applying pressure to the lower abdomen) to help facilitate bladder emptying. Assess the perineal area for skin breakdown related to incontinence. Measure postvoid residual volumes as prescribed to ensure that the client is not retaining large amounts of urine. Instruct the client to wait 20-30 seconds after voiding and then attempt to void a second time (ie, double voiding) to help empty residual urine.

Cervical Cap

The cervical cap is a barrier method of contraception used with spermicide (eg, nonoxynol-9). The reusable, cup-shaped cap is placed over the cervix before intercourse to block sperm from the uterus. To allow time for sperm to die, the cap should remain in place for ≥6 hours after intercourse but should not remain for more than 48 hours. The cap may remain in place for multiple acts of intercourse, but clients should confirm correct placement and insert additional spermicide into the vagina each time. Prior to insertion, spermicide is applied to the cervical cap to maximize contraceptive effectiveness. Spermicide should be applied inside the cap, along the rim of the cap, and in the groove on the underside of the cap. Use of cervical caps during menses (or during the postpartum period in clients with lochia discharge) increases the risk of toxic shock syndrome; an alternate contraceptive method should be used during this time. Inserting the cervical cap several hours before intercourse is acceptable and may improve correct use. Before each use, the client should inspect the cap for holes, cracks, or tears to ensure its effectiveness for blocking sperm.

AVF

The creation of an AVF for hemodialysis access involves an anastomosis between an artery and a vein (usually the cephalic or basilic vein). The fistula permits the arterial blood to flow through the vein, causing the vein to become larger in diameter and the walls to thicken, enabling blood to flow at high pressures. After the AVF is placed, it takes 2-4 months for it to mature to accommodate the repeated venipunctures necessary for hemodialysis access. The major complications of an AVF are infection (especially in end-stage kidney disease and diabetes), stenosis, thrombosis, and hemorrhage. Clients are taught the following preventive interventions: Report numbness or tingling of the extremity to the HCP to prevent neuromuscular damage. Do not allow anyone (other than dialysis personnel) to draw blood or take blood pressure measurements on the extremity to prevent thrombosis. Avoid wearing restrictive clothing or jewelry to prevent thrombosis Do not use the arm with vascular access to carry heavy objects (more than 5 lb [2.26 kg]); however, exercises to increase strength could include squeezing a soft ball or sponge several times a day. Check the function of the vascular access several times a day by feeling for vibration to assess for patency, stenosis, and clotting. Do not sleep on the arm with vascular access or use creams or lotions on the site. Monitor for signs of infection and bleeding after dialysis and report immediately Keep the site clean to help prevent infection

Cast Care

The edges of a cast may rub the client's skin and cause redness and irritation. This makes the client susceptible to skin breakdown and infection. The nurse should maintain smooth edges on the cast by placing cast padding over the edges that rub against the client's skin. The skin around the site should be kept clean, but the application of lotion will not stop the cast from rubbing against the client's skin. Objects should not be inserted into the cast at any time. The insertion of objects (eg, tongue blade) into the cast may abrade the skin underneath, increasing the risk for infection. Trimming and filing the cast may impair the integrity of the cast and may make the edges rougher, worsening irritation.

Bladder Cancer

The telltale symptom of bladder cancer, seen in >75% of cases, is painless hematuria; the client will report seeing blood in the urine but will have no associated pain. As with many other types of cancer, the primary factor contributing to bladder cancer is cigarette smoking or other tobacco use. Poorer outcomes are seen in those who have smoked longer and those who have smoked a higher number of cigarette packs per day.

Urge incontinence (UI)

also known as overactive bladder, occurs when the bladder contracts randomly, causing a strong, sudden urge to urinate that is followed by urine leakage. UI may occur without cause or may result from spinal cord injury and impairment of the bladder (eg, interstitial cystitis) or neurological system (eg, Parkinson disease, stroke). Interventions for clients with UI include: Loss of excess weight to reduce pressure on the pelvic floor. Anticholinergic medications (eg, oxybutynin, tolterodine) to decrease bladder spasms. Dry mouth (xerostomia) is a frequent adverse effect. Avoidance of bladder irritants (eg, artificial sweeteners, caffeine, citrus juices, alcohol, carbonated drinks, nicotine). Pelvic floor exercises (eg, Kegel) to strengthen the muscles and help prevent urinary leakage. Bladder training (eg, voiding every 2 hours while awake) and gradually lengthening intervals between voiding.

Chronic kidney disease (CKD) Dietary Intake

avoid excess intake of electrolytes (eg, sodium, potassium, phosphorus); the modifications may also include restricted intake of protein and fluid. Clients should be carefully instructed regarding sodium restriction because many foods (eg, deli meats, canned soups, frozen meals) are deceptively rich in sodium. If fluids are restricted, the nurse must teach the client to count intake of foods that liquify at room temperature (eg, gelatin, popsicles) toward total fluid intake. Clients with CKD should avoid potassium-rich foods (eg, avocados, bananas, oranges, salt substitutes). To prevent further kidney damage, clients with CKD should not consume a high-protein diet.

Classic signs of retinal detachment

include a curtain coming across the vision, floaters or lightning flashes in the vision field, and "gnats/hairnet/cobweb" throughout the vision. Aging can be a cause and can result in retinal tears or holes and spontaneous detachment. However, retinal detachment can also be caused by forceful head trauma. Retinal detachment requires emergent consultation and treatment as most untreated, symptomatic detachments result in blindness of the affected eyes.

Transurethral resection of the prostate (TURP)

involves insertion of a rectoscope to excise obstructing prostate tissue. Continuous bladder irrigation is initiated after the procedure. The large catheter and balloon apply direct pressure on the bleeding tissue and allow urine to drain. A specific rate is not prescribed; the irrigation flow is adjusted so that the urine remains light pink without clots. Typically, the irrigation rate will gradually decrease during the first 24 hours. Vital signs within normal limits indicate hemodynamic stability but not patency of the draining catheter from irrigation. Overall, the intake and output should be equal (considering approximately 400-500 mL/day of insensible loss). If the negative balance is ≥500 mL, further assessment/intervention is needed. However, fluid balance is not the best indicator of irrigation infusion rate in these clients. Painful bladder spasms are expected after TURP and catheter placement. The spasms are typically treated with belladonna-opium suppositories or other antispasmodics (eg, anticholinergics such as oxybutynin [Ditropan]). The nurse should remind the client to refrain from trying to void around the catheter as this can trigger the spasms.

Primary open-angle glaucoma

is a chronic condition in which aqueous humor does not drain properly, leading to elevated intraocular pressure (IOP) that causes optic nerve damage and progressive peripheral vision loss (eventually "tunnel vision"). Treatment focuses on minimizing vision loss and monitoring the IOP (eg, several times per year). Client teaching includes: Taking prescribed eye drops (eg, prostaglandin analogs, beta-adrenergic blockers, alpha-adrenergic agonists, cholinergic agonists, carbonic anhydrase inhibitors) for life and on time (eg, every 12 hours) to control IOP. Keeping all appointments with the health care provider (HCP) for continual monitoring of IOP. Consulting the HCP before taking over-the-counter medications with anticholinergic properties (eg, allergy, cough, or cold medications) to avoid increasing the IOP. Reporting sudden eye pain, halos around lights, and abrupt onset of blurry vision because these may indicate acute angle-closure glaucoma, a medical emergency that requires immediate surgical intervention.

Chronic heart failure (HF)

is a condition in which the heart is unable to adequately pump, reducing cardiac output and tissue perfusion. The client with chronic HF is at risk for acute HF exacerbations due to fluid overload. The nurse should ask the client about signs of acute exacerbation, which may require hospitalization for respiratory support (eg, high-flow nasal cannula) and diuresis: Shortness of breath (especially with exertion) Increased fatigue or weakness Pedal edema Weight gain of 3 lb (1.36 kg) over 2 days or 3-5 lb (1.36-2.26 kg) over a week Dizziness Clients with HF can reduce the risk of exacerbations through salt restriction, medication adherence, and monitoring of daily weights.

Acute angle-closure glaucoma

is a form of glaucoma that requires immediate medical intervention. Glaucoma disorders are characterized by increased intraocular pressure (IOP) due to decreased outflow of the aqueous humor, resulting in compression of the optic nerve that can lead to permanent blindness. In acute angle-closure glaucoma, IOP increases rapidly and drastically, which can lead to the following manifestations: Sudden onset of severe eye pain Reduced central vision Blurred vision Ocular redness Report of seeing halos around lights

Parkinson disease (PD)

is a neurological disorder causing decreased dopamine levels, uncontrolled activity of acetylcholine, and formation of abnormal protein clusters (ie, Lewy bodies) in the brain. PD causes both physical (eg, bradykinesia, tremor) and neurological (eg, mood alterations, dementia) symptoms. Because of these alterations, accommodations are often needed when nurses provide client teaching, including: Teaching and encouraging the client to speak slowly and exaggerate words, as speech disturbances are common in PD and may lead to frustration if misunderstandings occur. Identifying and promoting the client's strengths during teaching because cognitive and physical alterations in PD can negatively affect body image and lead to depression. Identifying times of day when the client functions optimally and scheduling teaching/activities during these periods, often late morning. Ensuring that teaching occurs at times without rushing or interruptions because several factors in clients with PD (eg, fatigue, depression, cognitive impairment) may impair the ability to process teaching quickly.

Endoscopic bronchoscopy

is a procedure in which the bronchi are visualized with a flexible, fiberoptic bronchoscope that is passed through the nose, mouth, or tracheal tube (ie, endotracheal or tracheostomy tube). The client receives moderate sedation (eg, midazolam [Versed]) to promote comfort during the procedure. A topical anesthetic (eg, lidocaine, benzocaine) is applied to the nares and throat to suppress the gag/cough reflexes, prevent laryngospasm, and facilitate passage of the bronchoscope. Bronchoscopy helps to diagnose respiratory diseases, obtain tissue samples for biopsy, and remove secretions, foreign objects, or abnormal tissue. Blood-tinged sputum is common and may occur after bronchoscopy due to irritation. However, hemoptysis or bright red respiratory secretions indicate bleeding that may progress to life-threatening hemorrhage, especially if a biopsy was performed. Other potential complications include hypoxia, hypercarbia (carbon dioxide retention), laryngospasm, bradycardia, and, rarely, pneumothorax.

Arterial steal syndrome

is an AVF complication that occurs when the anastomosed vein "steals" too much arterial blood, causing distal extremity ischemia. Symptoms occur distal to the AVF, including skin pallor, pain, numbness, tingling, diminished pulses, and poor capillary refill. Without prompt intervention, ischemia may lead to limb necrosis. After AVF creation, edema may occur due to venous congestion but typically improves spontaneously. Extremity elevation helps reduce edema. Severe or prolonged edema (eg, >2 weeks) could indicate venous hypertension that may require surgery to prevent AVF failure. (A loud swooshing sound (ie, bruit) auscultated over the AVF is expected due to turbulent blood flow at the arteriovenous anastomosis. Hand-grip exercises (eg, ball squeezing, hand flexing) are encouraged after AVF creation to promote fistula maturation. Postoperative surgical site pain is expected; however, pain distal to the AVF may indicate tissue ischemia.

Benign prostatic hyperplasia (BPH)

is an abnormal prostate enlargement that most commonly affects male clients age >50. The prostate gradually enlarges and compresses the urethra, causing voiding problems. Symptoms include urinary urgency, frequency, and hesitancy, dribbling urine after voiding, nighttime frequency (nocturia), and urinary retention. Treatment includes lifestyle changes and medications that shrink or slow growth of the prostate, and symptom management interventions (eg, voiding schedule, avoidance of caffeine and antihistamines). Surgical prostate resection may be required. Clients with BPH have increased risk for urinary tract infection (UTI) because of incomplete bladder emptying and urine retention. Symptoms of UTI are often similar to those of BPH; however, burning sensation with urination and cloudy/foul-smelling urine are specific UTI symptoms that require further assessment and treatment.

Primary open-angle glaucoma (POAG)

is an eye condition characterized by an increase in intraocular pressure and gradual loss of peripheral vision (ie, tunnel vision). The signs/symptoms of POAG develop slowly and include painless impairment of peripheral vision with normal central vision, difficulty with vision in dim lighting, increased sensitivity to glare, and halos observed around bright lights. POAG can lead to blindness if left untreated.

Pneumonia

is an inflammatory reaction in lungs, often due to infection, that causes production of cellular debris and purulent secretions that obstruct alveoli and prevent adequate oxygenation. Clinical manifestations of pneumonia include fever, tachycardia, low oxygen saturation, crackles, and productive cough with purulent sputum. Nurses caring for clients with pneumonia should facilitate airway clearance, improve oxygenation, and promote illness recovery by: Administering prescribed antibiotics after obtaining laboratory specimen cultures. Assisting the client to Fowler position to promote gas exchange and lung expansion. Administering supplemental oxygen to promote adequate tissue oxygenation. Obtaining sputum and blood specimens for culture to identify potential infectious organisms. Promoting adequate hydration with oral liquids or prescribed IV fluids to liquify and thin secretions, which promotes clearance of secretions and increased oxygenation

Cushing syndrome

is caused by prolonged exposure to excess corticosteroids, especially glucocorticoids. The most common cause is the administration of corticosteroids, such as prednisone or hydrocortisone. However, pituitary adenomas (tumors) can secrete adrenocorticotropic hormone, which stimulates the adrenal glands to produce too much cortisol. Clinical manifestations include: Androgen excess from adrenal gland stimulation, causing acne, hirsutism (facial, chest, or back hair in women), or menstrual irregularities (eg, oligomenorrhea) Metabolic complications such as hyperglycemia (ie, excess cortisol stimulating gluconeogenesis), hypertension, and truncal obesity (leading to insulin resistance); fat accumulation in the face ("moon face") and the back of the neck ("buffalo hump"), which is common. Skin changes from loss of collagen, such as easy bruising, purple striae, and skin thinning Muscle wasting and bone loss (ie, osteoporosis) due to steroid-induced catabolism, if the syndrome is not treated

Retinal detachment

is separation of the retina from the underlying epithelium that allows fluid to collect in the space. The signs/symptoms include sudden onset of light flashes, floaters, cloudy vision, or a curtain appearing in the vision.

Retinal detachment

is separation of the sensory retina from the underlying pigment epithelium with fluid accumulation. It can be a result of spontaneous atrophic retinal breaks or acute trauma. Common symptoms include a painless loss of vision "like a curtain" coming across the field of vision, lightning flashes, or a gnat/hairnet appearance in the vision field. This report needs emergent evaluation. Untreated symptomatic retinal detachment usually leads to blindness in that eye. In addition, this is the only listed presentation that is acute: the rule for prioritization is acute before chronic.

Addison disease

is the hypofunction of the adrenal cortex resulting in low levels of adrenal hormones (eg, glucocorticoids, mineralocorticoids, androgens) that contribute to maintaining fluid and electrolyte balance, blood pressure, and blood glucose. During stress (eg, infection, injury, psychological distress), the body typically increases production of adrenal hormones. However, this hormonal response in Addison disease is often insufficient to meet physiologic demands, which leads to Addisonian crisis. Addisonian crisis, or acute adrenocortical insufficiency, is a life-threatening complication of Addison disease that may be identified by hypotension, tachycardia, and generalized weakness. Without prompt intervention, shock may occur.

Retinal Detachment Primary Intervention

should include covering both eyes with patches to prevent further detachment. Up to 25% of clients who experience retinal detachment in one eye will also develop this in the other eye. Additional immediate interventions include placing the client on bed rest, notifying the health care provider or ophthalmology specialist, performing a visual acuity examination, and making the client npo for possible emergency surgery.

Following cataract surgery

the client will be instructed that, for several days (or until approved by the surgeon), activities that may increase intraocular pressure should be avoided to decrease the risk of damage to sutures or surgical sites. These include bending (eg, vacuuming floors, playing golf), lifting more than 5 lb, sneezing, coughing, rubbing or placing pressure on the eye, or straining during a bowel movement. The nurse should encourage this client to increase fluids and fiber in the diet as well as consider an over-the-counter stool softener or laxative. It may take 1-2 weeks before visual acuity is improved. It is common for the client to experience itching ("sand" in the eye), photophobia, and mild pain for several days following surgery. Purulent drainage, increased redness, and severe pain should be reported. Sleeping on 2 pillows will elevate the head and decrease intraocular pressure.

Macular degeneration

Age-related macular degeneration is a degenerative eye disease that brings about the gradual loss of central vision, leaving peripheral vision intact. Macular degeneration is a progressive, incurable disease of the eye in which the central portion of the retina, the macula, begins to deteriorate. This deterioration causes distortion (blurred or wavy visual disturbances) or loss of the central field of vision, whereas the peripheral vision remains intact. Macular degeneration has two different etiologies. "Dry" macular degeneration involves ischemia and atrophy of the macula that results from blockage of the retinal microvasculature. "Wet" macular degeneration involves the abnormal growth of new blood vessels in the macula that bleed and leak fluid, eventually destroying the macula. Progression of macular degeneration may be slowed with smoking cessation, intake of specific supplements (eg, carotenoids, vitamins C and E), laser therapy, and injection of antineoplastic medications. Risk factors for macular degeneration include advanced age, family history, hypertension, smoking, and long-term poor intake of carotenoid-containing fruits and vegetables.

TURP Spasms Treatment

Belladonna-opium suppositories or antispasmodics (eg, oxybutynin) are used for bladder spasms, an expected complication of the TURP procedure. Clients should be instructed not to urinate around the catheter as this would increase bladder pressure and spasms. Narcotics can be used for postoperative pain. If the urinary flow is adequate, a description of the pain would help to determine whether to give the client a narcotic or an antispasmodic. Before treating the resulting pain, the possibility of a physiological etiology for procedure-related pain (eg, blockage of urinary flow from blood clots) should be ruled out first.

Post Turp Procedure

Causes of postoperative pain from TURP with a CBI include a kinked blocked catheter, bladder spasms, and general postoperative pain. The nurse should ensure first that urinary flow is intact prior to treating the pain with analgesics.

Diabetic Retinopathy

Chronic hyperglycemia can cause microvascular damage in the retina, leading to diabetic retinopathy, the most common cause of new blindness in adults. A partial retinal detachment may be painless and cause symptoms such as a curtain blocking part of the visual field, floaters or lines, and sudden flashes of light.

Chronic Kidney Disease (CKD) Diet

Clients with chronic kidney disease (CKD) are at risk for fluid overload and hyperkalemia. Clients should avoid salt substitutes, which typically contain potassium chloride and may contribute to hyperkalemia.. To avoid further complications and prevent progressive kidney damage, clients with CKD are advised to utilize certain dietary restrictions, including: Sodium restriction - Avoid high-sodium foods such as cured meats, pickled foods, canned soups, frankfurters, cold cuts, soy sauce, and salad dressings. Potassium restriction - Avoid high-potassium foods such as raw carrots, tomatoes, and orange juice. Fluid intake monitoring - Monitor fluid intake closely and accurately, being careful to include foods that are liquid-based (eg, popsicles), because fluid is often restricted. Low-protein diet - Eat 0.6-0.8 g/kg/day of protein to help prevent progression of kidney disease. If the client is already on hemodialysis, increased protein intake is recommended to prevent malnutrition. Low-phosphorus diet - Avoid foods high in phosphorus (eg, chicken, turkey, dairy).

chronic kidney disease (CKD)

Clients with chronic kidney disease (CKD) have decreased glomerular filtration, resulting in retention of fluid, potassium, and phosphorus. Fluid retention is initially treated with sodium restriction and diuretic therapy. Dietary adjustments should also be made to reduce serum potassium and phosphorus. Laboratory values are key to determining allowable foods. Dairy products (eg, milk, yogurt) and certain fruits (eg, bananas, oranges, coconuts, watermelons, and avocados) contain high potassium levels. Dairy products also contain high phosphorus levels. Examples of allowable foods for CKD clients include apples, pears, grapes, pineapple, blackberries, blueberries, and plums.

Nursing Interventions for Hearing Impaired Clients

Clients with hearing impairment require accommodations to ensure understanding of client teaching. Nursing interventions for communicating with hearing-impaired clients include: Ensuring that the room is well-lit and sitting directly in front of the client. This helps improve clients' understanding by providing visual cues, such as facial expressions and hand gestures. Some hearing-impaired clients can also lip-read, which requires adequate visibility. Encouraging the client to repeat back instructions to evaluate understanding. Providing printed materials with visuals, such as pictures and illustrations, to supplement verbal instructions.

Meniere Disease Attack

During an attack, the client is treated with vestibular suppressants, including sedatives (eg, benzodiazepines such as diazepam), antihistamines (eg, diphenhydramine, meclizine), anticholinergics (eg, scopolamine), and antiemetics. The nurse's priority is to provide for client safety with fall precautions given the severe vertigo and use of sedating medications. Fall precautions include adjusting the bed to a low position with side rails up and instructing the client to call for help before getting up. Clients should be in a quiet, dark room and avoid sudden head movements to minimize vertigo and should not watch television or look at flickering lights to reduce stimulation. The client's diet should be salt restricted to prevent fluid buildup in the ear.

Hearing Loss Communication

Effective communication is the key to ensuring the safety of clients with hearing impairment. To avoid startling the client, the nurse should approach the client from the front and visibly gain the client's attention before speaking. The nurse should stand directly facing the client so that the speaker's face can be seen clearly. Facial expressions and gestures can help make the meaning clear. If clients communicate with sign language, a professional sign language interpreter should be used when needed. The nurse may post a hearing impairment sign at the head of the bed or on the door to inform all caregivers of the safety concern. Many clients with hearing impairment will lip-read. The room lights should be on so that the speaker's lips and face are well illuminated. When speaking to a client with hearing loss, speech should be directed toward the least-affected ear and should be at a normal volume. Raising the voice to speak loudly creates a higher pitch that is harder to understand. The nurse should ensure that any hearing aids are functional and in place before attempting to speak to the client.