"Med-surgical Nursing N214 Test two
Mod 4 The nurse is teaching the client about taking prophylactic warfarin sodium (Coumadin). Which statement indicates that the client udrstands how to take the drug. Select all that apply
*3-4 days for warfarin to achieve maximum dosage *effects of the drug continue for 4-5 days after last dose *I should have my blood tested periodically.
Mod 5 how do you Assessment of Pain?
*Pain- where? Precipitating factors. Anything relieve it? Aggravate it? *Quality- describe the pain *Radiation- diffuse pain that localizes in a specific location *Signs/symptoms/severity *Timing, onset/frequency
Mod 6 A patient who complains of unilateral eye inflammation and pain and pressure over his eye, blurred and decreased visual acuity, seeing halos around lights and nausea and vomiting. He is likely to have?
*acute angle-close glaucoma
Mod 4 Nursing interventions for stroke?
*administer stool softners don't want them to strain *maintain fluid and electrolyte balance *check swallow reflex !!!! *ensure adequate nutrition *watch for signs of pulmonary embolism *chest pain, sob, dusky color, changed sensorium *mouth care *turn patient every 2 hours to prevent pneumonia *meticulous eye care with sterile normal saline *help with range of motion *monitor for neurologic changes or complications associated with stroke and its treatment
Mod 4 What happens it a hemorrhagic stroke?
*an artery in the brain leaks, rapidly reducing the blood supply to the tissue served by the artery. Blood accumulates deep within the brain, causing even greater damage by further compromising neural tissue.
Mod 6 What is Marcus senile?
*an opaque, bluish white ring within the other edge of the cornea that is caused by a fat deposits. It is very common is older people and does not affect vision.
Mod 6 What activities increase intraoccular pressure?
*bending at the waist *lifting more than ten pound *sneezing, coughing *blowing your nose *straining to have a BM *vomiting *having sex *tight shirt collars *keeping the head in a defendant position
Mod 6 Retinal detachment teaching tips for patient are?
*blurred vision several days after surgery *instill eyedrops properly *rest for a few days *avoid driving *no heaving lifting for a few days
Mod 4 What are some signs and symptoms of a stroke?
*blurred vision/double vision/blindness in one eye/tunnel vision *weakness on one side (unilateral) *gait disturbance *numbness one sided (unilateral) *aphasia *dysarthria (slurred speech)
Mod 6 A gradually developing opacity of the lens can be found when the patient has?
*cataracts
Mod 6 What drugs can cause toxic cataracts?
*corticosteriods *phenothiazine derivatives *mitotic agents
Mod 6 What are some of the causes of retinal detachment?
*degenerative changes in the retina are most common other causes are: *trauma *systemic diseases such as DM *retinopathy or tumors
Mod 6 What disease can cause associated cataracts?
*dm *hypoparathyroidism *down syndrome *chronic sun light exposure
Mod 6 As we age our eyes appear sunken does this mean we are dehydrated?
*do not use eye appearance as an indicator of hydration status.
Mod 6 What is in the middle ear?
*epitympanum *malleus *ossicles *stapes *tympanic membrane
Mod 4 Big thing with stroke is rehabilitation afterwards.
*exercise therapy *use of assistive devices *swollow evaluation *speech therapy *disturbed thought process from brain damage *provide pictures for recognition *memory training *find a way to communicate with them if possible
Mod 4 Glascow coma scale is an neurological assessment tool nurses use. It has three categories. Name them?
*eye opening *verbal response *motor response
Mod 6 What symptoms will you see with retinal detachment?
*floaters *light flashes *sudden painless vision loss ******describe as a curtain that eliminates a portion of vision.
Mod 4 Where is most embolic strokes start from?
*heart and afib, ischemic heart disease or rheumatic heart disease. *Plaque breaking off the carotid sinus or internal carotid artery ( carotid US and Bruits)
Mod 6 Aging and eyes, what happens?
*iris has less ability to dilate which leads to difficulty to adapting to dark environments. *Older adults need additional light for reading and to avoid tripping over objects. *Lens yellowing reduces the ability of the eye to transmit and focus light. *The aging lens hardens, shrinks, and loses elasticity. As it loses elasticity the ability of the eye to accommodate is gradually lost.
Mod 6 How are there eyes post op?
*itchy *bloodshot *swollen eyelids *Avoid increases in Intraocular pressure
Mod 4 Your giving oral care to a patient who had a stroke what position should they be in and what must be readily available?
*lateral position to avoid aspiration *suction
Mod 4 What is something we can do as nurses to maybe prevent a stroke?
*listen to carotid arteries for bruits *get an ultrasound of carotid arteries if we suspect something.
Mod 6 This is a steady and slow disease process that might creep up on a patient in clonic open ended glaucoma what should you look for?
*mild aching in the eyes *gradual loss of peripheral vision ******* *seeing halos around lights *reduced visual acuity especially at night that uncorrectable.
Mod 6 What causes the increase in ocular pressure in open -angle glaucoma?
*obstruction occurring in the outflow through the trabecular meshwork or schlemm's canal causing increase pressure to damage the optic nerve.***
Mod 6 What are the types?
*open-angle:fluid in the eye does not flow properly through the drain of the eye, called the trabecular meshwork *acute angle-closure: Poor drainage is caused because the angle between the iris and the cornea is too narrow and is physically blocked by the iris. This condition leads to a sudden buildup of pressure in the eye *congenital: Born with it
Mod 6 What to look for in patients who might have cataracts?
*painless, gradual blurring and loss of vision *with progression whitened pupil *they see halos around lights *headlights cause a blinding glare *glare and poor vision in sunlight.
Mod 6 What is in the outer ear?
*pinna *mastoid process *external ear can
Mod 4 What are some nursing interventions for a patient who is experiencing aphasia?
*provide for picture recognition (memory)/pictures trigger memories from storage areas of the brain that are different from those used in speech. *structure the teach methods according to the patients organization of information/rationale: the patients organization of information will determine the logical sequence of learning for him or her. *Monitor the pt behavior during therapy/rationale:the pt mahout agitated and frustrated during therapy which signals the need to stop the session. *encourage the patient to use previous learned skills/rationale: distant memories may remain in tact and this gives the patient some self control *Assit the family to understand that assertive behavior may be the result of poor memory/rationale:aggressive or combative behavior by the patient may signal a threat to self esteem from memory loss. *request a neuropsychology consult to identify what areas need work.
Mod 6 What is Meniere's Disease?
*ringing in the ears (tinnitus) *vertigo *headaches *feeling of fullness in the ear *usually one sided excess of endolymphatic fluid that distorts the inner canal
Mod 6 What is in the inner ear?
*semicicular canals *cochlea *organ of court *vestibule
Mod 4 What can cause a hemorrhagic stroke?
*severe hypertension *ruptured aneurysm *rupture of an arteriovenous malformation (AVM) *cocaine abuse
Mod 4 What are modifiable risk factors for CVA?
*smoking *HTN *illegal drug use *atherosclerotic disease (high fat diet) *sedentary lifestyle *diabetes *heavy alcohol use
Mod 4 Stroke teaching tips for patient and family are?
*teach patient to comb hair, wash and dress if needed *obtain appliances such as walker, grab bars for tub or toilet and ramps as needed. *encourage pt to be speech therapy *rehabilitation *take aspirin as ordered/watch for gi bleed *watch for another stroke *severe headache/drowsiness/confusion/dizziness *keep all follow up apps
Mod 4 What are non modifiable risk factors of a CVA?
*trauma *sickle cell anemia *african American, Hispanic, American Indian *male *older age *atrial fibulation *valvular heart disease.
Mod 6 Tear production is reduced as we age, resulting in dry eyes, discomfort, and increased risk for corneal damage and eye infections. Teach the patient to?
*use saline eyedrops on a routine schedule to reduce dryness *increase humidity in the home
Mod 4 For a client who is experiencing expressive aphasia which nursing intervention is most helpful in promoting communication?
*using a picture board
Mod 6 What to teach the patient who has just had cataract outpatient surgery?
*wear sunglasses that filter out uv rays *avoid activities that increase intraoccqular pressure, such as straining with coughing or bowel movements or lifting heaving objects. *antibiotics subconjuctivally *vision should not be worse after surgery.
Mod 6 Seeing color discrimination between greens, blue and violets decreases as we age.
--
Mod 7 Name the hypotonic solutions?
0.45%NaCL
Mod 4 How much rtPA can you give?
0.9mg per kg of recombinant tissue plasminogen activator
Mod 7 What is the Normal of Magnesium (Mg2+) ?
1.3-2.1 mEq/dL elevated: hypermagnesemia; kidney disease; hypothyroidism; adrenal insufficiency low: hypomagnesemia malnutrition; alcoholism;ketoacidosis Calcium and Magnesium follow each other!!!
Mod 6 What is normal ocular pressure?
10-20mm
Mod 7 What is the Normal of Sodium (NA+)?
136-145 mEq/dL SEIZURE PRECAUTION elevated: hypernatremia; dehydration; kidney disease; hypercortisolism low: hyponatremia; fluid overload; liver disease; adrenal insufficiency Water follows NA+ !!
Mod 4 A client is being monitored for a TIA . She is orientated is orientated , can open her eyes spontaneously and follows commands. What is her Glasgow coma scale?
15
Mod 4 The glascow coma scale provides an easy way to describe a patient baseline mental status and to help detect and interpret changes from baseline findings. To use the scale test the patients ability to respond to verbal, motor and sensory stimulation and grade your finding according to the scale. If the patient is alert , follows simple command and is orientated to person, place and time his score will be?
15 points the highest possible score.
Mod 7 Normal osmolality is what concentration
275-295
Mod 7 Name the hypertonic solutions ?
3%NACL D5NS D10 D5LR
Mod 6 Six cardinal signs of gaze are testing cranial nerves?
3, 4, and 6
Mod 7 What is the Normal of Phosphorus (P) ?
3.0-4.5 mg/dL elevated: hyperphosphosphatemia; kidney disease; hypoparathyroidism;acidosis; hypocalcemia low: hypophosphatemia; chronic antacid use; hyperparathyroidism; Hypercalcemia; vitamin D deficiency; alcoholism; malnutrition Calcium and Phosphate are opposites
Mod 7 What is the Normal of Potassium (K+)?
3.5-5.0 mEq/dL elevated: hyperkalemia; dehydration; kidney disease; acidosis; adrenal insufficiency; crush injuries low: hypokalemia; fluid overload; diuretic therapy; alkalosis; insulin administration; hyperaldosteronism
Mod 4 What is the percentage of TIA that turns into CVA?
50-80%
Mod 7 What is the Normal for Calcium (CA2+) ?
9.0-10.5 mg/dl elevated: Hypercalcemia; hyperthyroidism; hyperparathyroidism low: hypocalcemia; vitamin D deficiency; hypothyroidism, hypoparathyroidism; kidney disease; excessive intake of phosphorus-containing foods or drinks. Calcium and Magnesium follow each other!!!
Mod 4 The maximum rtPA you can give to anyone is
90mg
Mod 7 What is the Normal of Chloride (CL-) ?
98-106 mEq/dL elevated: hyperchloremia; metabolic acidosis; respiratory alkalosis; hypercortisolism low: hypochloremia; fluid overload; excessive V& D; adrenal insufficiency; diuretic therapy
Mod 4 What is it when you are born with a spaghetti-like mass, with thin walled dilate vessels that is though of as a short circuit where blood does not go into the tissues but is pumped through the shunt and back to the heart without giving nutrients to the tissues?
AVM-arterioVenous Malformation
Mod 5 what is Neuropathic Pain?
Abnormal processing of pain by sensory input by peripheral or CNS. most challenging type of chronic pain non-cancer pains, it results from some type of nerve injury.
Mod 7 Early signs of hyponatremia are?
Acute Confusoin n/v/d intestinal changes-increase motility anorexia abdominal cramping
Mod 5 Pain Types?
Acute pain- serves a biologic purpose temporary & sudden onset <6 months, inc HR, Inc BP, Inc RR, Dilated pupils, Sweating. behavioral: restlessness inability to Concentrate, Apprehension, & overall distress Chronic pain- Persistent pain > 6 months associated with tissue injury that has healed or is not associated with Cancer, arthritis/chronic back pain. Serves no biologic purpose. non-cancer pain and cancer pain
Mod 4 What age makes a big difference in TIA's?
After 50 the incidence of tia resulting in stroke greatly increases.
Mod 4 What is Contraindicated for rtPA?
Age older than 80 Anticoagulation with an INR less than or equal to 1.7 INR normal range 2.0-3.0
Mod 7 Greatest contributor to fluid shift is sodium and it is controlled by what hormone?
Aldosterone
Mod 4 What meds after the emergency?
Anticoagulants/antiplatelets Not considered best practices by American Stroke Association ASA -prevent blood clotting by reducing platelet adhesiveness Bruising, hemorrhage, liver disease long term use Antiseizure meds Neuroprotective drugs (calcium channel blockers) prevent cerebral vasospasm-smooth muscle relaxer
Mod 6 what activities increase intraocular pressure?
Bending from the waist side lifting objects weighing more than 10 lbs. sneezing, coughing blowing nose straining to have bowel movement vomiting sex keeping head in a dependent position wearing tight clothes.
Mod 4 What men are the highest risk group?
Black men
Mod 4 After 24 hours we need to get a follow up
CT scan prior to starting anti platelet or anticoagulant drugs.
Mod 4 What test will they need immediately to tell us if they had an infarction or ischemia?
CT/takes approximately 10 minutes to scan the entire brain.
Mod 7 Hypocalcemia what is it?
Calcium < 9 mEq/L Normal calcium - 9.0-10.5 mg/dL Stored in bone Hypo less than 9.0 mg/dL Low levels increase sodium movement across excitable membranes which allows for depolarization to occur more easily Muscle spasms LOW think chevoski's and troussours sign- if you put a BP cuff on pt arm and arm flexes and stays like that = positive troussors sign. If you tap on pt cheek and it twitches = positive chevoski's sign. HIGH - think FATER CLOTTING TIMES means faster THROMBUS FORMS means YOU WILL FORM CLOTS you get cardiac changes Know how to treat both and what to do
Mod 7 What do you assess for in Hypercalcemia?
Cardiac- most serious and life threatening Increased HR and BP, severe= brady Assess for slowed/impaired blood flow (clots) Neuro- muscle weakness, altered LOC Intestinal- decreased peristalsis Constipation, vomiting, abd pain BS hypoactive
Mod 7 What mechanisms does our body use to keep ph in range?
Chemical buffers respiratory rate kidneys
Mod 6 ____are responsible for bright light and are responsible for snap, color vision.
Cons
Mod 7 What are crystaloids?
Crystalloids are solutions with small molecules that flow easily from the bloodstream into cells and tissues. Isotonic crystalloids contain about the same concentration of osmotically active particles as extracellular fluid, so fluid doesn't shift between extracellular and intracellular.
Mod 7 What are the isotonic fluids we give in IV?
D5W NS LR
Mod 7 Treatment of low Calcium?
Drug therapy- Calcium replacement (PO, IV) Give with vitamin D to help absorption Nutrition therapy- high calcium diet
Mod 7 the treatment of Hypercalcemia ?
Drugs - prevent increase in calcium like 0.9% sodium chloride IV NS (sodium intake increases kidney excretion of calcium) Diuretics that enhance excretion of Calcium Lasix calcium chelators (calcium Binders) Dialysis: when drug therapy has not work fast enough, and there is still of life threatening cardiac problems, it is used for rapid calcium reduction.
Mod 6 what is a nose bleed called and do?
Epistaxis Trauma, hypertension, leukemia, inflammation, tumor, decreased humidity, nose blowing, nose picking, chronic cocaine use, Men more than women ***Watch those patients on blood thinners!!
Mod 4 What about after the emergency?
Exercise Therapy Use of assistive devices Impaired Swallowing- Speech-language path Disturbed thought process Provide pictures for recognition Memory training Impaired Verbal communication- aphasia, agnosia
Mod 4 What is FAST in Strokes?
Facial weakness Arm weakness Speech problems Time to call 911
Mod 4 What is decerbrate posture?
Hand posturing away from the body indicating neurological damage. This way score less on the Glasgow coma scale. associated with a lesion of the diencephalon, pons or midbrain, usually. Ankles and toes are flexed.
Mod 4 What do you do when testing for stroke?
History and physical When did the symptoms start (important for ischemic treatment) Medical history Medications (blood thinners??) National Institutes of Health Stroke Scale (long)
Mod 7 What is ph measuring?
Hydrogen Ions in our body.
Mod 4 Patient will be admitted to?
ICU
Mod 7 For severe potassium loss what can we do?
IV potassium
Mod 4 Major complications of a stroke is?
Increased ICP during the first 72 hours
Mod 4 What are key features of ICP?
Increased Intracranial Pressure Decreased level of consciousness (LOC) (Lethargy to coma) Behavior changes; restleness irritability and confusion headache n/v (may be projectile) change in speech pattern aphasia slurred speech change in sensorimotor status pupillary changes: dilated and non reactive pupils )blown pupils) or constricted and nonreactive pupils cranial nerve dysfunction ataxia seizure (usually within first 24 hrs. after stroke) Cushing's triad sever hypertension widened pulse pressure bradycardia abnormal posturing: Decerabration (extensor): is abnormal posturing and rigidity characterized by extension of the arms and legs, pronation of the arms plantar flexion, and opisthotonos, dysfunction in the brainstem area Decortication (Flexion): is abnormal posturing seen in the patient with lesions that interrupt the corticospinal pathways. the patient's arms, wrist, and fingers are flexed with internal rotation and plantar flexion of the legs.
Mod 4 Nursing Diagnosis for Stroke?
Ineffective tissue perfusion Impaired swallowing Impaired physical mobility Self-care deficit Impaired verbal communication Disturbed sensory perception Risk for aspiration Risk for falls
Mod 7 Our plasma is equal to what type of fluid?
Isotonic
Mod 7 Your patient is NPO and status quo . What type of fluid do you anticipate the doctor ordering?q
Isotonic
Mod 7 What is osmolality?
It the percentage of dissolved solutes in a liter of fluid.
Mod 7 Who is the primary regulator of fluid output?
Kidneys
Mod 4 no. 1 sign of a stroke is a change in ?
LOC
Mod 7 what are the signs and symptoms of hypernatremia?
LOC decreased, confusion muscle twitching or irregular muscle contraction assess by handgrip and arm flexion against resistance cardiovascular changes like BP and HR HR is elevated with pt with hypernatremia and or hypovolemia quality of Apical pulse & peripheral Pulse thirst fatigue seizures
Mod 4 hemisphere Strokes Language feature
Left Aphasia: Inability to use or comprehend language Agraphia: loss of ability to write Alexia: reading or problems understanding written language Right Impaired sense of humor
Mod 4 hemisphere Strokes Memory feature
Left Possible Deficit Right disorientation to time, place, and person inability to recognize faces
Mod 4 hemisphere Strokes Behavior feature
Left Slowness cautiousness anxiety when attempting a new task depression of a catastrophic response to illness sense to guilty feeling of worthlessness worries over future quick anger and frustration intellectual impairment Right impulsiveness lack of awareness of neurologic deficits confabulation euphoria constant smiling denial of illness poor judgment overestimation of abilities (risk for Injury)
Mod 4 hemisphere Strokes Vision feature
Left inability to discriminate words and letters reading problems deficit in the right visual field Right visual spatial deficits neglect of the left visual field loss of depth perception
Mod 4 hemisphere Strokes Hearing feature
Left no deficit Right loss ability to hear tonal variations
Mod 7 What is Hypercalcemia?
Level above 10.5 mg/dL normal 9.0 -10.5 mg/dL Excitable tissues are less sensitive to stimuli Heart, muscles, nerves, intestine most affected Calcium needed by enzymes involved in clotting, Hypercalcemia leads to faster clotting times
Mod 7 what is Hypermagnesemia ?
Level above 2.1 mEq/L normal (1.3-2.1 mEq/dL) Increased intake of mag or decreased renal excretion of mag magnesium-containing antacids and laxatives IV magnesium replacement Decreased kidney excretion of magnesium resulting from kidney disease • FOLLOWS CALCIUM!!! SO if low calcium =low mag means= THINK chevoski and Troussors sings!!!!!!! • If high= cardiac arrest hypotension, and faster clotting times. REMEMBER it follows calcium
Mod 7 Hyperphosphatemia ?
Level above 4.5mEq/L Actually well tolerated by body Signs/symptoms are from LOW calcium decreased kidney excretion resulting from kidney disease tumor lysis syndrome increased intake of phosphorus hypoparathyroidism
Mod 4 Where is the most common spot for an embolic stroke
MCA /middle cerebral artery
Mod 4 What is better an MRI or CT?
MRI is better but it takes a lot longer. If patient is allergic to iv contrast, shellfish, or iodine they will need an MRI.
Mod 7 Hypophosphatemia common causes?
Malnutrition starvation use of aluminum hydroxide based antacids hypercalcemia hyperparathyroidism kidney failure hyperglycemia hyperalimentaton: artificial supply of nutrients, typically IV respiratory alkalosis uncontrolled diabetes mellitus alcohol abuse Effects related to decreased energy metabolism Also a low phos= high calcium. Will see most manifestations from high calcium level
Mod 5 What are some of the NON-Pharmacological therapies?
Massage TENS- transcutaneous electrical nerve stimulation Acupuncture Aromatherapy Distraction Hypnosis Relaxation Heat/cold meditation
Mod 7 Treatment for Hyperkalemia?
Monitor and monitor cardiac complications, patient safety for fall risk health teaching is the key to prevention stop K+intact drug therapy sodium polystyrene sulfonate (Kayexalate) may take hours if in severe hyperkalemia dialysis might be the only recourse
Mod 6 what are the tx for Epistaxis ?
Nasal Packing Gel Tampon Epistaxis Catheters (Rhapid Rhino)
Mod 5 What are Withdrawals from Pain?
Nausea, vomiting, abdominal cramping, muscle twitching, profuse perspiration, delirium, convulsions
Mod 5 what common chronic pain conditions?
Neuralgia's - damage to peripheral nerves caused by infection or disease (sharp pain) Reflex sympathetic dystrophy's - muscle wasting (burning pain) Hyperesthesias - over sensitivity to tactile and painful stimuli Myofascial pain syndrome - injury or disease to facial tissue Cancer pain - acute, chronic or intermittent
Mod 7 What are the sign of Hypomag?
Neuro- psychosis, confusion Intestinal- decreased intestinal motility
Mod 7 what is Hypomagnesemia ?
Normal 1.3-2.1 mEq/L 60% stored in bones Used for skeletal muscle contraction, carbohydrate metabolism, ATP formation, vitamin activation, cell growth Neuro- increased nerve impulse transmission Hyperactive deep tendon reflexes, numbness, tingling Can have +Chvostek and Trousseaus because low mag follows hypocalcemia CALCIUM AND MAGNESIUM follow each other !!!
Mod 7 Hypophosphatemia what is it?
Normal levels 3.0-4.5 mg/dL normal (3.0-4.5 mg/dL) Most in the bones Needed for activating vitamins and enzymes, forming ATP (cell energy) Food sources meats, fish, dairy, nuts Reciprocated with calcium
Mod 6 what is the involuntary and rapid twitching of the eyeball called?
Nystagmus
Mod 5 define pain according to Margo McCaffrey?
Pain is whatever the experiencing person says it is and exists whenever he or she says it does.
Mod 7 What is alkalosis ph levels
Ph above 7.45
Mod 5 what factors influence pain?
Physical Activity Anticipation Cultural response Past experience Emotions Knowledge Age Gender Meaning of Pain Degree of Attention Anxiety Fatigue Coping style Family Support
Mod 5 What is the Placebo Effect?
Placebo- medical treatment or nursing care that produces an effect in a patient because of its therapeutic intent and not because of its actual physical or chemical properties Placebo effect- when a patient responds favorably to a placebo Placebos only allowed with informed consent. Patient must agree to be in a controlled study and that the possibility exists that they could be receiving a placebo and not the actual medication. RN's are not allowed to administer placebos on their own accord!
Mod 6 What drug can we use for ocular hypertension with glaucoma?
Prostaglandin Agonist: dilating the blood vessel in the Trabecular mesh of the eye Adrenergic Agonist: bind to receptors reduce aqueous humor from ciliary bodies, improve fluid flow through the dilated pupil. Beta Adrenergic Blockers: blocking receptors, less aqueous humor produced by ciliary bodies and absorbed a little faster due to therapy. Cholinergic Agonist: decreasing the amount of aqueous humor and absorb better, dilate the pupil and increase the angle between the iris and the lens, better flow Carbonic Anhydrase Inhibitor: directly inhibiting prod. of AHumor from the zonules of the ciliary bodies, absorption not affected.
Mod 4 what labs will you need to order right away?
Prothrombin time (PT) Partial Thromboplastin time (PTT) International Normalized Ration (INR) May provide evidence that a hemorrhagic stroke has occurred.
Mod 4 What does PERRLA stand for?
Pupils equally round and reactive to light and accommodations.
Mod 7 What do you assess hypomagnesemia ?
Reduced membrane excitability Cardiac- brady, peripheral vasodilation, hypotension, CARDIAC ARREST Neuro- weak muscles, drowsy, lethargic,
Mod 6 What does the lens of the eye do?
Refracts and focuses light on the retina.
Mod 6 What causes Complicated Cataracts ?
Retinitis pigmentosa glaucoma retinal detachment
Mod 7 Sodium does what?
SODIUM- hypo/hyper always always : SIEZURE PRECAUTIONS ( 135-145 normal value) Teach your pt what foods not to eat and read labels on cans of how much sodium there is. If shoe or rings don't fit think sodium is HIGH ( water follows sodium)
Mod 6 what kind of retinal detachement are there?
Separation of the retina from the epithelium Rhegmatogenous- hole or tear in the retina caused by mechanical force-opening for the vitreous to move under the retina Traction- retina pulled away from support tissue by bands of fibrous tissue in the vitreous Exudative- fluid collecting under the retinal
Mod 7 what is Hyperkalemia?
Serum K+ over 5.0meq/L LEADS TO ALTERED CARDIAC FUNCTION Neuro-Muscles twitch early and then numbness. Leads to weakness and then paralysis Intestinal -increased motility Always ask lab about hemolysis in tube. Why? monitor cardiac and labs
Mod 7 Hypernatremia is sodium above
Serum Sodium > 145 mmol/L hyperaldosteronism kidney failure corticosteroids cushing's disease excessive oral sodium ingestion excessive administration of sodium-containing IV fluids watery diarrhea, dehydration
Mod 7 What are some causes of hyponatremia?
Serum Sodium Level < 136 mEq/L (mmol/L) excessive ADH diuretics (high ceiling) loop diuretics kidney disease ( scarred distal convoluted tubule) NPO low-salt diet hyperglycemia excessive hypotonic solution administration heart failure vomiting diarrhea **suctioning **diuretics
Mod 6 what are the sign and symptoms of retinal detachement?
Sudden and PAINLESS Bright flashes of light (photopsia) Floating dark spots "curtain being pulled over part of the visual field" Regardless of cause, surgical repair is almost always needed
Mod 7 Chvstek's signs ?
Tap the face below and in front of the ear (over facial nerve) to trigger facial twitching on one side of the face
Mod 6 Beta Adrenergic Blockers: blocking receptors, less aqueous humor produced by ciliary bodies and absorbed a little faster due to therapy.
Teach and ask does the pt has moderate to severe asthma or COPD diabetic check sugar level when on drug under Beta Blocker to check pulse twice a day for < 58 beats/ min, if so contact health care provider
Mod 6 Prostaglandin Agonist: dilating the blood vessel in the Trabecular mesh of the eye
Teach check location of abrasion or other signs of trauma eye color darkens and eyelash elongate with drug only one eye is to be treated, not pace drops to make other eye the same color
Mod 6 Adrenergic Agonist: bind to receptors reduce aqueous humor from ciliary bodies, improve fluid flow through the dilated pupil.
Teach to wear dark glasses outdoors and aslo indoors, when light is bright. ask if taking antidrepressants or MAOI don't use eye drops with contacts in, or wait 15 minutes after drops
Mod 6 How do you test visual acuity?
Test with and without glasses/contact lenses Snellen Chart Stand 20 feet from the chart Test each eye independently and then together
Mod 6 What is consenual response?
That is when the opposite pupil does the same thing.
Mod 6 What is direct response?
That is when you shine a light in the pupil and it constricts.
Mod 6 Why is closed angle glaucoma so dangerous?
The canal of scheme is totally blocked and pressure continues to rise and the optic nerve will be damaged.
Mod 7 What are the three process that control normal fluid and electrolyte balance?
The process are Filtration, Diffusion, and osmosis, they determine how, when, and where fluids and particles move across cell membranes.
Mod 6 What is retinal detachment?
The retinal layers split creating a sub retinal space. This space fill with fluid called a sub retinal fluid.
Mod 6 You have just had your eyes checked by a nurse using the senile chart. You have 20/50 vision . What does this mean?
The the patient can see at 20 feet what a healthy eye can see at 50 feet.
Mod 7 Late signs of hyponatremia are?
Think LOC:confusion,coma, convulsions.lethargic muscle twitching deep tendon reflexes diminish tremors cardiovascular changes-hypovolemia-rapid weak and thready pulse
Mod 4 What acute treatment for Ischemic Stroke?
Thrombolytic/Fibrinolytic Therapy Dissolves the cerebral artery occlusion and re-establishes blood flow Retavase/rtPA- tissue plasminogen activator Weight based
Mod 4 What is a TIA?
Transient ischemia attack is a temporary interruption of blood flow to the brain, that usually clears within 12 to 24 hours. Its usually considered a warning sign of an impending thrombotic stoke.
Mod 7 What is the Treatment of Hypomagnesemia?
Treatment Drugs-IV mag NO IM Assess for hypermag Oral mag can cause diarrhea and make mag loss worse
Mod 7 what are the Treatments for Hypermagnesemia?
Treatment- stop all mag supplements Give mag free IV fluids to reduce serum mag levels Always assess your patients Airway!! Lab work Look for causes of increased or decreased levels n/v/d, exercise, etc When treating your patient's, continuous assessment is required!!!
Mod 5 what will you see in acute pain?
Vital signs inc HR, inc BP, inc RR, Dilated pupils, Sweating
Mod 4 You tell your patient to lift up their hands and they just stare at you. You know this is ?
Wernikes aphasia
Mod 5 What is Withdrawals to pain?
Withdrawal/abstinence syndrome- physically dependent on opioids abruptly ceases using them (or if given Narcan/naloxone)
Mod 7 Trousseau's sign ?
a blood pressure cuff is placed around the upper arm, inflate to greater that patients systolic pressure, and keep the cuff inflated for 1-4 min. this will occlude the brachial artery. these hypoxic conditions, will cause in a positive sign, the hand and fingers go to spasm in palmar flexion.
Mod 5 describe Gate Control Theory of pain transmission?
a gating mechanism occurs in the spinal cord. Nerve Delta and C transmit pain impulses from the [periphery to the dorsal horn of the spinal cord (Substantia gelantinosa), where the gating mechanism occurs. When the gate is opened, pain impulses ascend to the brain, when the gate is closed the pain impulse do not get through and pain is not perceived. Medications, endorphins help close the gait Imagery and distraction help close the gate
Mod 4 What is the definition of an aneurysm?
a permanent localized dilation of an artery which enlarges the artery to at least two times its normal diameter. The can rupture and cause bleeding into the subarachnoid space, the ventricles and the intracerbral tissue.
Mod 4 What is wrenches aphasia?
ability to grasp the meaning of the spoken word is impaired. Ability to speak is not impaired but the flow of words is often not appropriate and broken. Reading and writing is severely impaired.
Mod 7 Potassium helps maintain?
acid-base balance
Mod 7 For moderate hypokalemia what can we do?
adequate oxygenation potassium supplements prevent k+ loss increase K+ levels safety IV infusion max infusion is 5-10 mEq/Hour to rapid infusion can lead to cardiac arrest Never Never, Never IV push tissue irritant-never give IM or SQ can cause extreme burning before infusing iv solution of KCL check and re-check the dilution of the drug.!!!!!!
Mod 4 Your patient can no longer read or write?
agnosia/general term for loss of sensory comprehension, may include an inability to write, comprehend reading,material, or use an object correctly.
Mod 4 Your patient asks you to write a phone no. down for them because they no longer can. This is?
agraphia
Mod 4 Your patient asks you to read a note because they cannot understand written language this is
alexia problems with written language.
Mod 4 What is an abnormal ballooning or blister along an artery called?
aneurysm
Mod 6 Your patient has pupils that are two different sizes and they were born that way. 5% of the public has this and its called?
anisocoria
Mod 4 Your patient just can't find the right words to express what they are trying to communicate. This is?
anomia
Mod 4 Sometime they use ?
antiseizure meds neuorprotective drugs (calcium channel blockers prevent cerebral vasospasm-smooth muscle relaxer
Mod 4 Your patient cannot express themselves in speech, writing or signs. The cannot comprehend spoken or written word. You know this is
aphasia/resulting from brain disease or trauma.
Mod 4 You patient cannot dial the phone you know this is?
apraxia loss of ability to carry out a purposeful motor activity.
Mod 6 What age typically deals with cataracts?
around 70
Mod 7 Hyperkalemia cause?
arrhythmias and heart block and death. serum K+ level >5 mEq/L
Mod 6 What is presbyopia?
as we age the accommodation is lost and the ability to see things close up , near point of vision, increases. Near objects especially reading material must be placed farther from the eye to be seen clearly.
Mod 6 Carbonic Anhydrase Inhibitor: directly inhibiting prod. of AHumor from the zonules of the ciliary bodies, absorption not affected.
ask for Allergy to Sulfonamide antibacterial drugs. shake the drug before applying don't use eye drops with contacts in, or wait 15 minutes after drops
Mod 4 The big risk with dysphagia is?
aspiration
Mod 4 If patient cannot take alteplase (tPA)
aspirin or heparin
Mod 7 Hypokalemia causes?
assess respiratory first arrhythmia reduces excitability of cells lungs weaker muscle weakness breathing can be shallow cardiac-weak and thready pulse neuro-altered mental status decreased movement of intestinal tract decreased peristalsis
Mod 6 This is a refractive error caused by unevenly curved surfaces on or in the eye, especially of the cornea. These uneven surfaces distort vision?
astigmatism
Mod 4 You notice your patient is walking funny gait and has seemed to lose their balance a lot this is
ataxia-gait disturbance or loss of balance, possible brainstem or cerebellum danage
Mod 4 What are most ischemic stroke associated with?
atherosclerosis
Mod 6 The most common presbycusis is called sensory prebycusis which result from
atrophy of the Corti and auditory nerve ***high pitch ranges are usually lost
Mod 6 What type of lens corrects nearsightedness or myopia?
biconcave lens
Mod 4 Where is the most common site for a thromolitoc stoke?
bifurcation of the common artery and vertebral artery.
Mod 6 What race has the highest incident of glaucoma?
blacks
Mod 4 What is an ischemic stroke?
blockage of a cerebral artery by a thrombus or embolus. A stoke is a sudden interruption of circulation in one or more blood vessels to the brain. During a stroke the brain tissue fails to receive adequate oxygenation resulting in serious tissue damage or necrosis. Usually associated with development of atherosclerosis.
Mod 4 Patient has signs of a stroke find out if they are on?
blood thinners
Mod 4 Congenital aneurysm means you were?
born with it.
Mod 4 If this patient has a bp over 180/105 they will also need?
bp meds
Mod 4 Your patient calls you in and just keep saying I want blah blah. You know this is?
broca's aphasia
Mod 7 How does Hyponatremia manifest?
by the excitable cellular activity, with less sodium makes depolarization slower so that excitable membranes are less excitable. as a result water moves into the cell causing swelling, due to osmolarity of the ECF is lower then that of the ICF.
Mod 6 What is it when we have a gradually developing opacity of the lens or lens capsule of the eye?
cataract
Mod 4 What is a thrombus?
clot
Mod 4 Maintain communication with patient. If he's aphasic set up a simple method of?
communicating
Mod 4 The client has an ischemic stroke and is treated with rtPA. What vital do you need to watch diligently?
control of blood pressure is critical during the first 24 hours after treatment because of an intra-cerebral hemorrhage is the major adverse effect of thrombolytic therapy.
Mod 7 Potassium balance is influenced by?
controlled by kidney function through aldosterone, and controlled by Sodium/Potassium Pump
Mod 6 Hyperopia or farsightedness is corrected with what type of lens?
convex
Mod 6 Patient with Menieres can have severe vertigo for up to a
couple hours where they are holding on to objects. Attacks can last for several days
Mod 6 What can we do as nurses if our patient experience diplopia, double vision?
cover with a patch over affected eye. Remind the nursing staff to ensure a safe environment by removing clutter from the room.
Mod 7 IV fluid replacement falls into two broad categories?
crystalloids and colloids
Mod 7 We replace fluid with
crystalloids and colloids
Mod 7 Treatment for hyperkalemia is?
decrease diet intake of potassium take off potassium sparing diuretic **administer glucose and insulin *administer calcium to counteract high potassium *administer kayexalate
Mod 6 What causes anisocoria?
defect in efferent nervous pathway controlling the pupil traveling in the oculomotor nerve, parasympathetic fibers, or the sympathetic pathways.
Mod 6 The most common cause of retinal detachment is?
degenerative changes in the retina or vitreous.
Mod 4 Patients with dysphagia often don't get enough food or fluids and this means they are?
dehydrated constipated
Mod 7 Hypophosphatemia treatment?
discontinue drugs that promote phosphorus loss oral repacemtn of phosphorus along with a vit D supplement. nutritional therapy You may eat fish, beef, chicken, pork organ meats nuts whole grain breads and cereals
Mod 4 What is the expected outcome of thrombolytic drug therapy for a stroke?
dissolved emboli
Mod 7 Treat hypervolemia with?
diuretic
Mod 6 As we age our eyelids may relax and fall away from the eye this leads to?
dry eyes
Mod 4 Your patient has slurred speech you know this is?
dysarthria
Mod 6 Your patient pupils are abnormally shaped, this is called?
dyscoria, or they can have an abnormal reaction.
Mod 4 Your patient has trouble swelling or chewing food. As a nurse you know this is?
dysphagia
Mod 6 What is when you have the perfect refraction of the eye with the lens at rest.light rays form a distance 6m or more are focused into a sharp image on the retina?
emmetropia
Mod 4 How often will we perform neuro-assessments on a patient getr tPA?
every 15 minutes during infusion and then every 30 minutes
Mod 7 What are the Common causes
excessive oral intake of Calcium excessive oral intake of vit D kidney failure use of thiazide diuretic hyperparathyroidism direct invasion of cancer cells hyperthyroidism immobility dehydration and use of glucocorticoids
Mod 7 sodium is the major electrolyte in ?
extracellular fluid
Mod 6 Beta-Adrenergic Blockers ?
eye drops, timolol, a beta blocker that reduce ocular hypertension by blocking beta-adrenergic receptors so less aqueous humor is produced by the ciliary bodies. the fluid also appears to be absorbed slightly faster.
Mod 7 Potassium imbalance affect our heart and can be
fatal serum K level < 3.5 mEq/L normal K+ level (3.5 - 5.0 mEq/L) 98% K+ in cells major cation of the ICF - hypo/hyper-HEART RATE AND RHYTHEM HEART RATE AND RHYTHM!!!!!. (3.5-5 normal ) remember book says : LOW K = AIRWAY! Because decrease potassium, muscles can't function. You get cramps everything fails (LUNGS AND HEART) and HIGH K = HEART RATE AND RHYTHM. ITS in your book. Just remember K+ = HEART RATE AND RHYTHM Know how to administrate potassium.
Mod 7 Other than heart issues what are the signs of hyperkalemia?
fatigue paresthesia dyspnea muscle-twitching cramping diarrhea
Mod 6 What causes a yellowish tinge to the sclera?
fatty deposits
Mod 7 What is the treatment for Hyponatremia ?
find the cause of low sodium hypertonic solution (2%-3%) IV saline infusion Drug therapy excrete water but not sodium drugs like - Conivaptan (Vaprisol) or tolvaptan (Samsca) ADH antagonist like Lithium, and demeclocycline (Declomycin) replace hormones as needed
Mod 6 What happens to the cornea as we age?
flattens
Mod 7 Changes in osmolality cause change in ?
fluid shift
Mod 7 How much of our body fluids in intracellular?
forty percent
Mod 4 A score of 5 equals?
full range of motion
Mod 4 What is an artery that has the whole circumference dilation called?
fusiform
Mod 6 12.5 % of all new cases of blindness are due to ?
glaucoma
Mod 7 Our body cannot live or function without?
glucose electrolytes
Mod 4 The brain cannot store?
glucose or oxygen, so if there is a block everything after the block is dying.
Mod 4 How should you position a patient with ICP?
head of bed at 30 degrees/never lye them flat HOB at 30 degrees Head in midline, neutral position to help promote venous drainage Avoid extreme head/neck flexion Avoid cluster nursing care Hyperoxygenating Pt before suctioning to prevent cerebral dilation Quiet environment Low lights Watch BP closely Watch for fever
Mod 6 What is prescycusis?
hearing loss slowly and progressively from old age.
Mod 4 Which stroke is more deadly ischemic or hemorrhage?
hemmorhagic Intraparenchymal hemorrhage Intraparenchymal hemorrhage occurs when a blood vessel to the brain ruptures and bleeds, causing rapidly increasing pressure in the brain. Subarachnoid hemorrhage A subarachnoid hemorrhage occurs when an aneurysm (blister-like bulge of the wall of an artery) ruptures over the surface of the brain, creating an explosive burst of blood between the brain and the skull, causing a build-up of pressure that damages the brain
Mod 4 Patient came into the hospital via ER after snorting cocaine and complains of severe headache and high blood pressure. It may be
hemorrhagic stroke from cocaine abuse (this cause their blood pressure to spike up suddenly)
Mod 7 What cause hypokalemia?
high doses of loop diuretics, Lasix digitalis corticosteroids V/D hyperinsulin hyperalimentation water intoxication strenuous activity severe vomiting and diarrhea
Mod 4 Your helping a patient with dysphagia with lunch . Make sure the patient is in what position? fluids are ___? Should they have food and what else?
high fowlers position thickened liquids food eaten on unaffected side distractions free zone, they have to concentrate on eating and swallowing.
Mod 7 Water moves from an area of low osmolality to
high osmolality.
Mod 7 Infusing a large amount of D5 can cause what?
hyperglycemia
Mod 7 High doses of glucocorticoids or estrogens can cause
hypernatremia
Mod 7 Patients with diarrhea, fever, burns, are high chance of ?
hypernatremia
Mod 6 ____ this occurs when the eye does not refract light enough. As a result image actually fall, or converge, behind the retina. Vision beyond 20 feet is normal but they have poor close vision.
hyperopia
Mod 6 Constriction of retinal vessels is a sign of ?
hypertension
Mod 7 Acute hypernatremia. What type of IV would we infuse?
hypotonic
Mod 7 Because dextrose is metabolized quickly it is sometimes considered a _____ solution?
hypotonic
Mod 7 Your patient has severe burns what type of fluid will you anticipate them needing?
hypotonic
Mod 7 For all fluid imbalances the primary goal is to ?
identify and correct the cause of the imbalance
Mod 7 What do we need to know prior to giving a plasma expander?
if patient has a dextran allergy.
Mod 7 So crystalloids can move and colloids stay
in the intravascular fluid, plasma
Mod 7 Common cause of hypocalcemia ?
inadequate oral intake of calcium lactose intolerant malabsorption syndrome: celiac sprue crohn's disease inadequate intake of Vit D end stage kidney disease kidney failure - polyuric stage diarrhea, steatirrhea wound drainage (especially Gastrointestinal)
Mod 7 For mild hypokalemia what will we do?
increase potassium rich foods
Mod 6 What is glaucoma?
increased ocular pressure, causes damage to your eye's optic nerve and gets worse over time. It's often associated with a buildup of pressure inside the eye
Mod 5 what is nociceptive pain?
is either visceral: pain arises from organs, Somatic: pain arises from the skin and musculoskeletal structures
Mod 7 What is Diffusion?
is the free movement of particles (solute) across a permeable membrane from an area of higher concentration to an area of lower concentration. facilitated diffusion: diffusion across a cell membrane that requires the assistance of a membrane-altering system (like Insulin for Glucose since the membrane is not permeable to glucose)
Mod 7 What is Filtration?
is the movement of fluid through a cell or blood vessel membrane because of HYDROSTATIC pressure difference on both sides of the membrane, occurs because of difference in water volume pressing against confining walls. when a gradient exist (when HP is not the same on both sides) water filtration occurs until the HP is the same on both spaces.
Mod 7 What is Osmosis?
is the movement of water only through a selectively permeable (semipermeable) membrane. for osmosis to work a membrane must separate two fluid spaces and one space must have particles that cannot move through the membrane, because of size or charge. therefore only the water particles move across the semipermeable membrane. the concentration equilibrium occurs by the movement of water rather then the movement of the solute particles.
Mod 4 Which stroke is more common ischemic or hemorrhagic?
ischemic
Mod 6 What happens to the intraoccqular pressure as we age?
it becomes slightly higher
Mod 5 what are the neuropathic pain divided to?
it is divided into centrally or peripherally generated pain. it is usually described as burning (most common), shooting, stabbing, and feeling "pins and needles"
Mod 7 What is tonicity?
its the relative concentration of the IV fluid.
Mod 4 What is a true aneurysm?
its when the arterial wall has become weakened by congenital or acquired problems.
Mod 7 Hypernatremia no. 1 cause is
kidney disease
Mod 7 is when potassium levels are >5mEq/L and can be caused by?
kidney malfunction too much potassium in diet potassium sparring diuretics/aldactone
Mod 7 sodium is regulated by?
kidneys and aldosterone NA dec = Adrenal Cortex to secrete Aldosterone = Inc Retention of NA and H2O
Mod 6 The eye can adjust its focus by changing the curve of the?
lens
Mod 6 What are age related cataracts from?
loss of water and fiber compaction
Mod 6 Rods respond to
low intensity light and shades of gray.
Mod 7 Your patient has hypernatremia, what sort of treatment would they be on?
low sodium drug therapy main medical intervention 0.225% NACL hypotonic IV infusion Lasix (potassium excreting if good kidneys) Cellular uptake Insulin sodium bicarbonate calcium gluconate-cardiac cell membrane stabilization Elimination Kayecalate Dialysis
Mod 6 The ___allows provides the sharpest vision allowing us to read and recognize faces.
macula
Mod 7 Sodium is essential for?
maintain osmolarity acid base balance water balance hypo/hyper always : SIEZURE PRECAUTIONS ( 135-145 normal value) Teach your pt what foods not to eat and read labels on cans of how much sodium there is. If shoe or rings don't fit think sodium is HIGH ( water follows sodium)
Mod 4 A stroke is a ?
medical emergency/get to the hospital immediately. Time is everything in a ischemic stroke being reversed.
Mod 6 Who has more of a chance of getting presbycusis elderly men or elderly women?
men
Mod 4 What is another name for TIA's?
mini stroke or silent stroke
Mod 6 When pupils are exposed to light they constrict this is called?
miosis
Mod 7 What are colloids?
molecules that are too big too move so they remain in the intravascular space .
Mod 4 Your patient cannot express in writing or making sounds or speaking you know this is
motor/expressive aphasia
Mod 4 What is an embolus?
moving clot which can lodge in heart, lungs or brain.
Mod 7 Signs and symptoms of hypokalemia are?
muscle weakness lethargy anorexia dysrhythmia cardiac arrest **think muscle and nerves
Mod 6 When you are in a dark setting the pupils dilate this is called?
mydriasis
Mod 6 This disorder when the image is focused in from of the retina. Close up vision is good but distance vision is poor.
myopia
Mod 7 Potassium is essential for ?
nerve and muscle function. Remember the heart is a muscle.
Mod 7 What do electrolytes do?
nerve conduction, membrane permeability, water balance, and critical body functions.
Mod 4 Nurses assess motor strength in all extremities a score of 0 means
no muscle contraction
Mod 6 Do these eye drops improve lost vision?
no, but help prevent more damage.
Mod 6 Do cataract patients wear a patch?
no, its usually a bilateral procedure.
Mod 6 Unequal pupil usually means?
nuero damage
Mod 7 Hypocalcemia assessments?
nutritional history - intake of diary products frequent painful muscle spasm - Charley horse in calf or foot during rest paresthesias often occur in the hands and feet tingling and numbeness trousseau's signs Chvostek's signs
Mod 6 A pupil that doesn't react to light ( a fixed pupil) can be a?
ominous neurological sign.
Mod 4 Give them a bolus of 10% of the rtPA over?
one minute
Mod 6 Which one is more common open-ended glaucoma or closed angle glaucoma??
open ended
Mod 7 Treat dehydration with
oral and IV fluids
Mod 6 What age does glaucoma usually occur?
over age 40
mod 7 causes of hyperkalemia?
over ingestion of potassium containing foods or medications salt substitutes potassium chloride rapid infusion of potassium-containing IV solutions adrenal insufficiency kidney failure K-sparing diuretics ACE's inhibitors Acidosis Hyperuricemia uncontrolled diabetes mellitus
Mod 5 how is pain transmitted?
pain is transmitted from primary afferent fibers (delta myelinated mechanical nociceptors (rapid) & C unmyelinated in muscle, periosteum, ad viscera n chemical (slow) peripheral fibers) to the dorsal horn of the spinal cord. The fibers synapse with spinothalamic neurons, which cross over and then ascend the spinal cord to the thalamus.
Mod 6 What is photophobia?
painful oversensitivity to light. Can be from medication or disease process. Teach patient to keep room dim and to wear sunglasses when in the sun.
Mod 4 What happens is a tia?
patient loses some function: unilateral blindness, unilateral weakness or numbness, speech deficit or others but the regain full function quickly.
Mod 6 Meniere's disease has repeated episode which eventually causes?
permanent hearing loss
Mod 7 What is acidosis lab values?
ph below 7.35
Mod 6 What makes vision possible?
photoreceptor neurons rods and cones.
Mod 4 During rtPA administration do not?
place invasive lines/they will already have an IV Discontinue infusion if patient reports headache, has severe HTN, nausea, vomiting, or bleeding. Prepare for STAT head CT
Mod 7 Patient is in hypovolemic shock we are going to give a
plasma expander/colloids/and vasopressors
Mod 7 Colloids rapidly expand what?
plasma volume
Mod 7 What are electrolytes?
positively charged or negatively charged inorganic particles Sodium, Potassium, Calcium, Chloride, Magnesium, Phosphorus
Mod 4 What is decorticate posturing?
posturing toward the spinal cord indicating neurological damage. This is associated lesion of the corticospinal tract near the cerebral hemisphere, midbrain dysfunction. Legs are stiffly extended internally rotated and feet plantar flexed.
Mod 4 How does aspirin work?
prevents blood clotting by reducing platelet adhesiveness.
Mod 6 Which type of glaucoma is most common?
primary open angle, Most common Both eyes Asymptomatic in early stages Outflow of aqueous humor (anterior) though the chamber is reduced IntraOcularPressure (IOP) gradually increases
Mod 5 What is addiction to pain?
primary, chronic neurobiological disease with genetic, psychosocial, and environmental factors influencing its development. Behaviors include: impaired control over drug use, compulsive use, continued use despite harm, craving Occurs over time, not one hospital stay American Society for Pain Management (ASPMN)
Mod 5 Delta Fibers carry what?
rapid, sharp, pricking, or piercing sensation and generally localized, known as mechanical Nociceptors
Mod 6 What does the retina do?
receives information and transmits to the brain for processing.
Mod 4 Sensory aphasia is
receptive Loss of ability to comprehend spoken word auditory lost the ability to understand sounds visual-lost of the ability to understand printed or written figures (like an address, phone no.)
Mod 7 Our fluid/acid base balance is regulated by three hormones?
renin aldosterone ADH
Mod 6 Which is a priority nursing diagnosis for a client with Menieres disease during an attack?
risk for injury
What is called when only part of the vessel has an outpouching in the only one part of the artery?
saccular
Mod 6 Cone receptors are responsible for ?
seeing color
Mod 4 A low score in one or more categories may signal an impending neurological crisis. A total score of 7 or less indicates?
severe neurological damage
Mod 7 Your giving a hypertonic fluid. What happens to intracellular fluid?
shifts from intracellular to extracellular to give the venous system fluid. Remember we must profuse to keep our organs working.
Mod 7 Dehydration can lead to?
shock, and circulatory collapse, death
Mod 6 As we age our pupils get?
smaller
Mod 7 Water follows?
sodium
Mod 7 Normal saline or 0.9 sodium chloride contains what?
sodium and chloride
Mod 7 water retention, blood pressure and blood volume are all regulated by ?
sodium movement
Mod 7 Lactated ringer contains what?
sodium, potassium, calcium, chloride
Mod 6 How do the get rid of the old lens?
sound waves shatter it into pieces and a new lens in put in.
Mod 4 What is Broca's aphasia?
speech is reduced. They can utterance of about four words.Understand speech relatively well. reading and writing is limited.
Mod 4 Dysarthria patient needs what asap for chance of recovery?
speech pathologist
Mod 5 What is tolerance to pain?
state of adaptation in which exposure to a drug induces changes that result in a decrease in one or more of the drugs effects over time.
Mod 4 Flaccid one side of a face is a sign of a
stroke
Mod 6 What can we do for cataracts?
surgery Extracapsular Removal- front portion of the capsule is opened with a small incision and the lens is removed Phacoemulsification- probe is inserted through the capsule and high-frequency sound waves break the lens into small pieces (suctioned) Small clear plastic lens in used to replace it.
Mod 4 What intervention can we do for a hemmorhagic stroke?
surgery???
Mod 5 what is pseudoaddiction to pain ?
syndrome created by under treatment of pain Characterized by anger, escalating demands for more or different medication. Behaviors resolve when pain is effectively treated
Mod 4 Increase ICP causes unequal pupils as a result of pressure on the third cranial nerve. Increasing ICP causes an increase in what else?
systolic pressure which reflects the additional pressure need to profuse the brain. tt increase the pressure on the vagus nerve which thus produces bradycardia and it cause an increase in temperature from hypothalamic damage.
Mod 6 Cholinergic Agonist: decreasing the amount of aqueous humor and absorb better, dilate the pupil and increase the angle between the iris and the lens, better flow
teach pt not use more then prescribed drops report increase salivation or drooling tot he health care provider teach pt to use good light when reading, take care in darker rooms.
Mod 4 The patient has had a ischemic stroke the goal is to get them alteplase within
the first three hours.
Mod 7 Colloids pull fluid into
the intravascular fluid thus increasing osmotic pressure
Mod 4 What is the biggest factor in a stroke relating to recovery?
the speed at which circulation is restored determines the patients chance of recovery.
Mod 4 Watch a patients cheek if one side balloons with respiration thats the side of ?
the stroke.
Mod 5 C fibers carry what?
thermal, chemical, and strong mechanical impulses. more diffuse (widespread) and DULL, burning, or achy (persistent pain)
Mod 4 Unequal pupils means increase ICP and damage to what cranial nerve?
third cranial nerve
Mod 7 What is the most important regulator of fluid?
thirst
Mod 4 What is a secular aneurysm?
this is a weak spot in an artery wall, it is the most common aneurysm.
Mod 4 What is a false aneurysm?
this is when a vessel injury or trauma occurs to all three layers of the arterial wall.
Mod 4 What is consensual response?
this means when you shine a light in one eye the other eye pupil will constrict too. This is an appropriate response.
Mod 4 How does rtPA work on a ischemic stroke
thrombolytics activate plasminogen, which degrades the thrombus by breaking down fibrin. The most important factor in whether or not to give rtPA is the time LSN (Last Seen Normal)
Mod 7 If a patient has too much sodium (hypernatremia) they will pull fluid from the cells and cause them
to shrink, it will pull the water from the cells (ICF) into the ECF, causing severe cellular dehydration.
Mod 6 Make sure patients over 40 get an annual ?
tonometric examination to be proactive against glaucoma.
Mod 6 What is the name of the test to test intraoccular pressure?
tonometry: applies pressure to the outside of the eye until it equals the pressure inside the eye indicated when the cornea begins to indent.
Mod 6 Patients who need more help then they eye drops they can do a laser surgery to open up the canal called?
trabeclectomy , which creates a drainage hole for the iris and shunts are placed.
Mod 7 How much of our body fluid is extracellular?
twenty percent
Mod 6 Does retinal detachment happen unilateral or bilateral?
usually unilateral
Mod 7 What are causes of fluid and electrolyte loss?
vomiting, laxatives, suctioning, diarrhea, perspiration, burns, hemorrhage, excessive diuresis, ketoacidosis
Mod 4 Hemorrhagic stroke what do we do?
watch and wait to see if the body absorbs blood on its own. These are almost always deadly.
Mod 4 A patient arrives at the emergency room with a CVA what is vital information we need?
when did it happen/rtPA needs to be given within three hours of incident if possible
Mod 6 Who is Menieres disease common in?
white men
Mod 6 Is closed angle glaucoma an emergency?
yes the iris moved against the cornea and blocks the canal of scheme and the pressure increases. This happens suddenly.
