Galen Med Surg Exam 2

Who am I? Condition within the inner ear that can lead to a progressive loss of hearing. The symptoms are dizziness or vertigo, hearing loss, and tinnitus (ringing in the ears).

Meniere's Disease

Who am I? Throbbing, unilateral pain behind one eye that progresses to whole head

Migraine headache

What is unique about the side rails on a patient's bed that is on seizure precautions

Padded

Who am I? Progressive and chronic disease Degradation of dopamine​ Dopamine helps control motor function

Parkinson's Disease

If stroke occured in the L side of the brain, the nurse can expect to see

Patient may have difficulty with speech, easily agitated, more anxiety/ depression, reading & writing issues, vision could be cut in half

Who am I? inflammation and sensitivity with bronchoconstriction reversible airway obstruction

Asthma

Impaired ability to coordinate movement

Ataxia

Involves brief loss of tone. Can be confused with fainting

Atonic

How to medically treat Cataracts?

*Surgical removal of cataract​ Post-operative antibiotics and anti-inflammatories​ Have patient wear dark glasses until pupils react to light again​ Wear patch to prevent rubbing of eye​ Avoid activities that increase intraocular pressure (bending over, straining)

Pt. is post-lumbar puncture, what finding/observation would be of concern and would require to call the MD?

-Leakage of CSF -Changes in LOC -Decreased strength and sensation in lower extremities -bleeding from puncture site

Acute asthma attack nursing responsibilities include?

1. Assess/maintain open airway (priority) 2. continuous breath sound assessment (admin meds, then check again) 3. Position patient in High Fowler's 4. Tx: Give O2 is necessary (Goal =95-100%), SABA, steroids, IV magnesium 5. have patient use peak flow meter. Get a baseline (personal best) so the readings can be compared. Patient exhales as hard as they can to get a reading.

What are 4 modifiable risk factors that can lead to Parkinsons?

1. Well water​ 2. Low Estrogen​ 3. Industrial/Chemical metals​ 4. Exposure to pesticides and herbicides (unmodifiable risk- being over the age of 40)

A patient has a history of chronic obstructive pulmonary disease. The patient's oxygen flow rate should be set to no more than _____ L/min.

2-4

When is the flu contagious?

24 hours before symptoms begin and up to 5 days after they begin Rapid onset all body is involved

How long in between eye drops for Glaucoma do you need to wait before putting in another?

5 minutes in between admin of different eye drops

How long are patients that experienced a stroke at risk for increased intracranial pressure?

72 hours

What is a normal O2 sat for a patient with COPD?

88-92% is normal

The nurse observes a client with late-stage Alzheimer disease eat breakfast. Afterward the client states, "I am hungry and want breakfast." What is the nurse's best response? a."I see you are still hungry. I will get you some toast." b."You ate your breakfast 30 minutes ago." c."It appears you are confused this morning." d."Your family will be here soon. Let's get you dressed."

A Use of validation therapy with clients who have late-stage Alzheimer disease involves acknowledgment of the client's feelings and concerns. This technique has proved more effective in later stages of the disease because reality orientation only increases agitation.

To promote airway clearance in a patient with pneumonia, what should the nurse instruct the patient to do? (Select all that apply.) A. Maintain adequate fluid intake. B. Splint the chest when coughing. C. Maintain a 30-degree elevation. D. Maintain a semi-Fowler's position. E. Instruct patient to cough at end of exhalation.

A. Maintain adequate fluid intake. B. Splint the chest when coughing. E. Instruct patient to cough at end of exhalation. Maintaining adequate fluid intake liquefies secretions, allowing easier expectoration. The nurse should instruct the patient to splint the chest while coughing. This will reduce discomfort and allow for a more effective cough. Coughing at the end of exhalation promotes a more effective cough. The patient should be positioned in an upright sitting position (high Fowler's) with head slightly flexed.

Generalized seizure involving sudden, brief LOC, usually in children. Appears that they are staring off into space

Absence epilepsy

After patient is discharged from cataract surgery, what is one thing that the nurse should teach the patient about sleeping/position?

Avoid lying on side of the affected eye the night after surgery

Which finding below represents a positive Romberg Sign in a patient with multiple sclerosis? A. The patient report dark spots in the visual fields during the confrontation visual field test. B. When the patient closes the eyes and stands with their feet together they start to lose their balance and sway back and forth. C. The patient's sign and symptoms increase when expose to hot temperatures. D. The patient reports an electric shock feeling when the head and neck are moved downward.

B. This is an example of a positive Romberg's Sign.

Be carefule of giving elderly __________________ b/c they do not respond well. it can increase risk of confusion and constipation.

Benadryl (antihistamines)

Causes jerking of the muscles/ joints

Clonic

What are s/s the nurse would observe in elderly patients?

Decreased LOC gas and cough reflex diminished lethargic weakness confused

What are some nursing responsibilities for patient that experienced a stroke?

Elevate HOB Give O2 if less than 94% Quiet environment Make sure patients neck is in straight alignment Avoid sudden and acute hip or neck flexion Keep room lights low Closely monitor BP, heart rhythm, O2 sat, blood glucose, and body temp

Who am I? A disorder characterized by loss of lung elasticity with trapping of air, retained carbon dioxide, and dyspnea Without full expiration, decreases inhalation. Distends chest cavity. Barrel Chest High RR

Emphysema

What kind of precuations will a patient with Parkinson's disease be on?

Falls (due to orthostatic hypotension) and Aspiration precautions (will affect all movements as disease progresses including gag reflex) keep suction available due to being a choking hazard.

True or False: Multiple Sclerosis tends to affect men more than women and occurs during the ages of 50-70 years. True False

False: MS affects WOMEN more than men and shows up during the ages of 20-40 years.

Affects entire brain

Generalized epilepsy

Who am I? Increased pressure in the eye Intraoccular drainage is disrupted Open angle (still has some drainage) Closed angle (no drainage) Vision is foggy, gradual loss & loss of peripheral vision Halo around the eyes Vision can not be restored

Glaucoma

What disease would require the following medical treatment: 1. Timolol: reduces production of aqueous humor (Beta Blocker) 2. Pilocarpine: opens the meshwork allowing drainage of fluid (Cholinergic)​ 3. Mannitol: osmotic diuretic which decreases aqueous humor

Glaucoma (med rx)

What kind of diet will a patient with parkinsons be on?

High calorie, high protein Given in 4-6 smaller meals per day

What are some nursing interventions for Rhinosinusitis?

Humidification nasal sprays neti pot to clear out sinuses hot packs or warm compress to help vasodilate Saline spray

What 4 medications will a patient with TB need? How long will they take them?

INH Rifampin PZA EMB Take all 4 meds for first 8 weeks Then INH & Rifampin for another 18 weeks

What will nurse expect to see if patient had a stroke in the R brain

Impulsive Poor judgment Unable to recognize faces May be unaware the inability to use their paralyzed side Disoriented to time and place

What are some nursing responsibilities for a patient with pneumonia?

Increased fluids to 3L/day Give O2 if sat are low advise to avoid crowds teach frequent hand washing use incentive spirometer to expand lungs 10x/hr TCDB q2hrs encourage to stop smoking bronchodilators encourage vaccine give antibiotics if bacterial

Who am I? Chronic, progressive degenerative disease​ Autoimmune​ Inflammatory​ Issues with nerve transmissions

Multiple Sclerosis

Brief muscle jerks, lasts seconds

Myoclonic

The client is prescribed to have 80% oxygen administered continuously in a noninvasive manner. Which type of delivery system should you select to meet these criteria?

Nasal cannula

What are 2 big indicators of dyspnea?

Nasal flaring difficulty get words out

What populations are higher risk to have a stroke?

Native American, Alaskans, African American and Latinos

Patient begins to have a seizure. The nurse immediately wraps her arms around the patient to attempt to protect patient from hurting herself. Is the nurse following seizure procedure?

No. patient should never be restrained. Allow movements

What should the nurse do once seizure is over?

Nurse should stay with patient. patient may be confused or not know what happened. Reorient. Assess VS Keep patient laying on side Assess for patent airway and O2 sat Allow patient to rest Document

Who am I? Soft tissue collapses in the upper airway blocking flow of air​

Obstructive Sleep Apnea

What are a/s of a migraine headache?

Pain, N&V, photohobia, photosensitivity

How do you treat autoimmune diseases

Plasmapheresis

Who am I? excess fluid from inflammation in the lungs viral or bacteria s/s: increased rr, dyspnea, hypoxemia, cough, rust colored sputum(purulent, bloody), fever, chest discomfort, chills

Pneumonia

Which vaccine should a nurse encourage a client with chronic obstructive pulmonary disease (COPD) to receive?

Pneumonia vaccine (Pneumococcal)

Which nursing intervention would you use to prevent injury in the client receiving oxygen therapy by continuous nasal cannula?

Providing mouth care every 8 hours

Who am I? Contagious Airborne transmission a persistent, productive cough with bloody sputum (hemoptysis) is a common symptom of:

Pulmonary TB (also see night sweats, low grade fever, fatigue, chest tightness, chills, & weight loss)

What disorder has the following risk factors? Enlarged tonsils obesity large uvulae short neck smoking

Sleep Apnea (risk factors)

After administration of TPA in a patient that had a stroke, what would need to be done to determine TPA therapy was working?

Repeat CT scan

Who am I? Can happen in two different ways: - Sudden & painless w/ flashes of light and floating dark spots - If partial detachment, then it looks as a curtain is being pulled back • Separation of layers in retina from epithelium

Retinal Detachment

Who am I? Inflammation of sinuses, related to common cold usually viral leads to build of fluid and pressure s/s: pain, tenderness over sinuses, tetth pain, worse when bending over, and headaches

Rhinosinusitis

What 4 medications will a patient with TB be prescribed?

Rifampin Isoniazid PZA EMB

What is the only test that will definitively indicate that a patient has TB?

Sputum specimen

Who am I? Asthma attack that does not stop Patient will get Iv and bronchodilators wheezing and labored breathing see the use of accessory muscles and distended neck veins

Status Asthmaticus

Who am I? prolonged seizure lasting longer than 5 minutes or repeated seizures over 30 minutes. Life threatening and medical emergency

Status Epilepticus

Recognize the signs of a ______________: Balance Eye: blurred or doubled Face: drooping/weak Arm: one side paralysis/ weakness Speech: Slurred, disorganized or cant speak Time: need to dx QUICKLY

Stroke

Who am I? Permanent interruption of blood flow to the brain Can be due to a blockage or thrombus Can be hemorrhagic Causes tissue death of the brain which results in loss of function

Stroke 2 types: Ischemic and hemorrhagic

Patient with migraines is at risk for what?

Stroke and epilepsy

A patient is taking Phenytoin for treatment of seizures. Which statement by the patient requires you to re-educate the patient about this medication? A. "Every morning I take this medication with a full glass of milk with my breakfast." B. "I know it is important to have my drug levels checked regularly." C. "I will report a skin rash immediately to my doctor." D. "This medication can lower my body's ability to clot and fight infection."

The answer is A. This medication should NOT be taken with milk products or antacids because it affects absorption. All the other options are correct

This is the area in the brain which controls language processing

Wernicke's area

The work of breathing is increased with COPD, which in turn increases the patient's:

caloric requirements High calorie/ high protein 4-6 small meals

During the physical examination of patients with COPD, the thorax is inspected for the classic:

barrel-chest shape

What are late symptoms of COPD?

clubbing cyanosis JVD weight loss polycythemia

What is the #1 priority for the nurse when patient has a seizure

maintain patent airway

A white lipid covering of axons

myelin sheath

Who is at highest risk for airway obstruction?

patients with decreased LOC Dehydration unable to cough risk for aspiration unable to communicate

What breathing technique should the nurse teach a patient with COPD?

pursed lip breathing

What position should the nurse place patient having seizure?

side lying

What medications can you take for the Flu?

the flu is viral so there is no antibiotic but if you catch it early, patient can take tamiflu within the 1st 24 hours of symptoms beginning and it will lessen the symptoms by 2-3 days

A nurse is caring for a patient that experienced a stroke, which side would the nurse approach the patient?

the unaffected side (Always should face the door)

How will the nurse effectively communicate with the patient with hearing loss?

-position herself in front of the patient ​so they can read your lips -room well lit ​ -no distracting noise ​(quiet environment) -do not shout

How many negative sputum cultures does it take for a person with TB to be considered no longer infectious?

3

A 73-year-old female patient who lives alone is admitted to the hospital with a diagnosis of pneumococcal pneumonia. Which clinical manifestation, if observed by the nurse, indicates that the patient is likely to be hypoxic? A. Sudden onset of confusion B. Oral temperature of 102.3° F C. Coarse crackles in lung bases D. Clutching chest on inspiration

A. Sudden onset of confusion. Confusion or stupor (related to hypoxia) may be the only clinical manifestation of pneumonia in an older adult patient. An elevated temperature, coarse crackles, and pleuritic chest pain with guarding may occur with pneumonia, but these symptoms do not indicate hypoxia.

. A patient is suspected of having multiple sclerosis. The neurologist orders various test. The patient's MRI results are back and show lesions on the cerebellum and optic nerve. What signs and symptoms below would correlate with this MRI finding in a patient with multiple sclerosis? A. Blurry vision B. Pain when moving eyes C. Dysarthria D. Balance and coordination issues E. "Pill rolling" of fingers and hands G. Heat intolerance H. Dark spots in vision I. Ptosis

A, B C, D, and H. If lesions are present on the optic nerves, optic neuritis can occurs which can lead to blurry vision, pain when moving the eyes, and dark spots in the vision. If cerebellar lesions are found, this can affect movement, speech, and some cognitive abilities. This would present as dysarthria (issues articulating words), and balance/coordination issues. "Pill rolling" of the fingers and hands is found in Parkinson's disease. Ptosis is common in myasthenia gravis, and heat intolerance in thyroid issues.

You have a patient who has a brain tumor and is at risk for seizures. In the patient's plan of care you incorporate seizure precautions. Select below all the proper steps to take in initiating seizure precautions: A. Oxygen and suction at bedside B. Bed in highest position C. Remove all pillows from the patient's head D. Have restraints on stand-by E. Padded bed rails F. Remove restrictive objects or clothing from patient's body G. IV access

A, E, F, and G. The bed needs to be in the LOWEST position possible, a pillow should be underneath the patient's head to protect it from injury, AVOID using restraints (this can cause musculoskeletal damage).

For which patients with pneumonia would the nurse suspect aspiration as the likely cause of pneumonia (select all that apply)? A. Patient with seizures. B. Patient with head injury. C. Patient who had thoracic surgery. D. Patient who had a myocardial infarction. E. Patient who is receiving nasogastric tube feeding

A. Patient with seizures. B. Patient with head injury. E. Patient who is receiving nasogastric tube feeding.

1. While walking to the bathroom a patient begins having a generalized tonic-clonic seizure. What should the nurse do first? a. Reduce external stimuli. b. Maintain the patients airway. c. Maintain the patients privacy. d. Perform a brief neurological assessment.

ANS: B The prime objective in caring for a patient experiencing a seizure is to prevent injury. Maintain a patent airway, and if possible, turn the patient on his or her side to prevent aspiration if vomiting occurs. Do not force an airway or anything else into the patients mouth once the seizure has begun. C. D. Assessment and privacy are important, but airway always takes priority. A. Reducing stimuli will not help once the seizure has begun.

3.A 17-year-old patient with a new onset of seizures is diagnosed with epilepsy. What should the nurse include in the patient teaching? a. Aspirin can inhibit the action of anticonvulsants. b. Sudden withdrawal of anticonvulsants can lead to status epilepticus. c. Anticonvulsants must be taken frequently during the day to prevent seizures. d. When the seizures have been controlled, the medications can be discontinued.

ANS: B Sudden discontinuance of a medication can result in status epilepticus. A. Aspirin does not interfere with anticonvulsants each drug has different interactions that should be checked and communicated to the patient. C. The schedule is also dependent on the drug some may be needed only once or twice a day. D. Medications for epilepsy will most likely be needed lifelong.

A patient with a newly diagnosed seizure disorder is being prepared for discharge. What medication should the nurse anticipate will be prescribed for the patient to prevent recurrent seizures? a. Selegiline (Eldepryl) b. Haloperidol (Haldol) c. Gabapentin (Neurontin) d. Dexamethasone (Decadron)

ANS: C Gabapentin is an anticonvulsant agent. D. Dexamethasone is a steroid. B. Haloperidol is an antipsychotic agent. A. Selegiline is used to treat Parkinsons disease.

What are risk factors for seizures?

Alcohol abuse​ Drug abuse​ History of stroke​ Family history​ (genetics, alzheimers, Traumatic brain injury​ Sleep deprivation​ Stress​ Meningitis Infection Vascular

What does a positive TB test look like?

Area of induration =10mm or greater in healthy adults If patient is immunocomprised, area of induration= 5mm or greater Redness does not mean it is positive

What is a major cause of death in Parkinson's disease?

Aspiration Pneumonia

Select all the TRUE statements about the pathophysiology of multiple sclerosis: A. "The dendrites on the neuron are overstimulated leading to the destruction of the axon." B. "The myelin sheath, which is made up of Schwann cells, is damaged along the axon." C. "This disease affects the insulating structure found on the neuron in the central nervous system." D. "The dopaminergic neurons in the part of the brain called substantia nigra have started to die."

B and C. In multiple sclerosis the myelin sheath (which is the insulating and protective structure made up of Schwann cells that protects the axon) is damaged. MS affects the CNS (central nervous system) and when the myelin sheath becomes damaged it leads to a decrease in nerve transmission.

The nurse is ordered to administer Lorazepam to a patient experiencing status epilepticus. As a precautionary measure, the nurse will also have what reversal agent on standby? A. Narcan B. Flumazenil C. Calcium Chloride D. Idarucizumab

B. Flumazenil is the reversal agent for Lorazepam, which is a benzodiazepine.

What class of medication will break a seizure?

Benzodiazepines

What are the 4 "cardinal" signs of Parkinson's disease?

Bradykinesia​ (slow movement, loss of normal swing when walking, blank expression) Resting tremor​ (1st symptom, commonly in hands and arms, pill rolling) Rigidity​ (increased resistance to passive movement) Postural instability (uneven, slouched over) (there are others as well)

This is the area in the brain which controls speech

Broca's area

Who am I? Bronchial inflammation characterized by increased production of mucus and chronic cough

Bronchitis

What medication is used during an asthma attack that will quickly open the airways?

Bronchodilator SABA ex. albuterol

What are some ways to prevent a stroke?

Low fat/ heart healthy diet exercise stop smoking take your meds (anticogulant) control hypertension stop substance abuse

The nurse is teaching the daughter of a client who has middle-stage Alzheimer disease. The daughter asks, "Will the sertraline my mother is taking improve her dementia?" How would the nurse respond about the purpose of the drug? a."It will allow your mother to live independently for several more years." b."It is used to halt the advancement of Alzheimer disease but will not cure it." c."It will not improve her dementia but can help control emotional responses." d."It is used to improve short-term memory but will not improve problem solving."

C Drug therapy is not effective for treating dementia or halting the advancement of Alzheimer disease. However, certain psychoactive drugs may help suppress emotional disturbances and manage depression, psychoses, or anxiety.

Your patient has a history of epilepsy. While helping the patient to the restroom, the patient reports having this feeling of déjà vu and seeing spots in their visual field. Your next nursing action is to? A. Continue assisting the patient to the restroom and let them sit down. B. Initiate the emergency response system. C. Lay the patient down on their side with a pillow underneath the head. D. Assess the patient's medication history.

C. The patient is reporting signs and symptoms of an aura (this is a warning sign before a seizure event). Lay the patient down on their side with a pillow underneath the head and remove any restrictive clothing. Also, time the seizure. If the seizure lasts more than 5 minutes or if the patient starts to have seizures back-to-back activate the emergency response system.

The nurse cares for a 50-year-old patient with pneumonia that has been unresponsive to two different antibiotics. Which task is most important for the nurse to complete before administering a newly prescribed antibiotic? A. Teach the patient to cough and deep breathe. B. Take the temperature, pulse, and respiratory rate. C. Obtain a sputum specimen for culture and Gram stain. D. Check the patient's oxygen saturation by pulse oximetry.

C. Obtain a sputum specimen for culture and Gram stain. A sputum specimen for culture and Gram stain to identify the organism should be obtained before beginning antibiotic therapy. However, antibiotic administration should not be delayed if a specimen cannot be readily obtained because delays in antibiotic therapy can increase morbidity and mortality risks

What is pill rolling and what disease process do you see this in?

CLENCHED FIST WITH THUMB MOVING AROUND

What are some non pharmacological means to decrease migraine pain?

Caffeine Cold compress on the back of neck Increase fluids reduce stress meditation acupuncture botox chiropractor

If patient is experiencing status epilepticus, what will the nurse do?

Call rapid response immediately Establish an airway #1 priority

Who am I? Lens opacity or cloudiness, blurry vision, decreased visual acuity Visual impairment​ Blurry, cloudy, hazy, foggy​ Diplopia​ Halos visible especially when looking at a light during night-time driving

Cataracts

Area at the base of the brain where the anterior, middle, and posterior cerebral arteries join together

Circle of Willis

Involves altered LOC. Patient may have amnesia after the seizure. Hard to diagnose because it can resemble dementia

Complex epilepsy

Which cranial nerve would be affected if the patient is having difficulty chewing and clenching their jaw?

Cranial Nerve V-Trigeminal nerve

Who am I? Breakdown of the area involved in central vision Deterioration of the macula Central vision declines slowly- first just a distortion in their vision and then they will lose all central vision Patients complain of mild burning No cure

Macular degeneration

After teaching the wife of a client who has Parkinson disease, the nurse assesses the wife's understanding. Which statement by the client's wife indicates that she correctly understands changes associated with this disease? a."His masklike face makes it difficult to communicate, so I will use a white board." b."He should not socialize outside of the house due to uncontrollable drooling." c."This disease is associated with anxiety causing increased perspiration." d."He may have trouble chewing, so I will offer bite-sized portions."

D Because chewing and swallowing can be problematic, small frequent meals and a supplement are better for meeting the client's nutritional needs. A masklike face and drooling are common in clients with Parkinson disease. The client would be encouraged to continue to socialize and communicate as normally as possible. The wife should understand that the client's masklike face can be misinterpreted and additional time may be needed for the client to communicate with her or others. Excessive perspiration is also common in clients with Parkinson disease and is associated with the autonomic nervous system's response.

A 7-year-old male patient is being evaluated for seizures. While in the child's room talking with the child's parents, you notice that the child appears to be daydreaming. You time this event to be 10 seconds. After 10 seconds, the child appropriately responds and doesn't recall the event. This is known as what type of seizure? A. Focal Impaired Awareness (complex partial) B. Atonic C. Tonic-clonic D. Absence

D. This is an absence seizure and is most common in children. The hallmark of it is staring that appears to be like a daydreaming state. It is very short and the post ictus stage of this type of seizure is immediate.

What is the priority nursing intervention in helping a patient expectorate thick lung secretions? A. Humidify the oxygen as able. B. Administer cough suppressant q4hr. C. Teach patient to splint the affected area. D. Increase fluid intake to 3 L/day if tolerated.

D. Increase fluid intake to 3 L/day if tolerated. Although several interventions may help the patient expectorate mucus, the highest priority should be on increasing fluid intake, which will liquefy the secretions so that the patient can expectorate them more easily.

What will the nurse need to be sure she documents about a patient's seizure?

Document time seizure BEGAN and when it ENDED. note what type of seizure it was, what body parts were effected and was the patient conscious?

difficult, poorly articulated speech generally caused by interference in control over the muscles of speech and damage to central or peripheral nerve. can be slurred or slowed

Dysarthria

During a patient episode of Meniere's disease, what are the nursing responsibilities?

Encourage bed rest Encourage use of a medical alert bracelet Assist with ambulation due to fall risk

What would the nurse teach a patient dealing with hearing loss?

Ensure the correct administration of otic medications​ Confirm communication techniques​ Instruct patient on care of hearing aid (if needed)​ Teach ways to preventing injury​ Encourage early detection of hearing loss

Chronic disorder with 2 or more seizures experienced by the patient

Epilepsy

Who am I? Chronic disorder with 2 or more seizures experienced by the patient

Epilepsy

What kind of precautions would a patient that had a stroke be on?

Fall precautions Aspiration precautions (NPO until swallow study done)

Who am I? Acute viral respiratory infection​ S/s: Headache, cough, fever, chills, fatigue, sore throat, weakness Strain A: ex. aches and fever Strain B: ex. N&V and diarrhea droplet precaution

Influenza

B/c a stroke can cause dead tissue in the brain, WBCs travel to the brain to clean it. This causes edema and can cause increased ______________ _______________.

Intracranial Pressure (brain swell)

If a stroke occurs in the right hemisphere patients will be affected on what side of the body?

Left and vice versa.

What are some post-op teaching for patients that had surgery to correct their retinal detachment?

Limit reading for 3-5 weeks Wear dark glasses during the day and a patch at night Avoid squinting and straining Follow medication regimen as prescribed Avoid lifting heavy objects or any strenuous activity Make sure to attend follow up appointments as scheduled

If a patient with TB begins the medication regimen required, what lab will the nurse need to monitor?

Liver enzymes Meds very damaging to liver. Monitor for Jaundice- sclera of eye and skin yellow and dark urine due to bilirubin being excreted

Infection, Autoimmune disease & stressors can cause MS. What are some of the stressors that can trigger MS?

Physical injury ​ Emotional stress ​ Pregnancy ​ Fatigue ​ Living in cold climates

Who am I? The inflammation leads to a build up of fluid and pressure and can lead to infection​

Rhinosinusitis

If patient receives an inhaled steroid, what is something the patient should be advised to do?

Rinse mouth after medication. It can cause thrush.

What disease has the following risk factors? Allergy exposure (dust, pollen) GERD Certain meds (Asprin, NSAIDS) Illness Exercise Bronchitis Heat/ humidity anxiety

Risk Factors for Asthma

Which disease would you see these signs and symptoms? Decreased vision/ double or blurry/ nystagmus Hyperalgesia​ Vertigo Paresthesia​ Facial pain Muscles weakness, fatigue Tremors Unsteady gait memory impairment

S/S for Multiple Sclerosis

With a patient on seizure precautions, what 2 items will the nurse want to be sure are available at bedside?

Suction and oxygen

What are some common causes for status epliepticus?

Sudden withdrawal from antiepileptic drugs • Infection • Acute alcohol or drug withdrawal • Head trauma • Cerebral edema • Metabolic disturbances

Patient with parkinsons is due for his meds. What is another sign that the patient is due for meds?

Symptoms will begin to appear usually tremor. Important: meds are always given on time, each time.

If the patient seeks medical help within 4.5 hours of onset of symptoms of a stroke, what kind of therapy can be administered to help reverse symptoms?

TPA therapy (clot buster) Must be ruled as an ischemic stroke Must be placed on bleeding precautions for 24 hours Must get BP down before TPA starts

When would patient use abortive therapies for migraine headaches?

Take as soon as the symptoms start Ex: APAP/ Butalibital (Fioricet) NSAIDS Triptans (sumitriptan)/ ergotamines (cafergot)

What kinds of recommendations need to be made as a nurse when educating a patient about migraines headaches?

Teach patient to take meds at first sign of migraine Keep diary- symptoms and how well meds are working -Provide dark, quiet room with decreased stimuli -Identify triggering factors: stress, alcohol, wine, artificial sweeteners, MSG foods, - Advise patient to try yoga, meditation, acupuncture or massage Advise to take B12 and magnesium

A patient with a history of epilepsy is taking Phenytoin. The patient's morning labs are back, and the patient's Phenytoin level is 7 mcg/mL. Based on this finding, the nurse will? A. Assess the patient for a rash B. Initiate seizure precautions C. Hold the next dose of Phenytoin D. Continue to monitor the patient

The answer is B. A normal Phenytoin level is 10 to 20 mcg/mL. The patient's level is low; therefore, the patient is at risk for seizures. The nurse should initiate seizure precautions. Remember a patient being under medicated is a trigger for developing a seizure.

You're assessing your patient load for the patients who are at MOST risk for seizures. Select all the patients below that are at risk: A. A 32-year-old with a blood glucose of 20 mg/dL. B. A 63-year-old whose CT scan shows an ischemic stroke. C. A 72-year-old who is post opt day 5 from open heart surgery. D. A 16-year-old with bacterial meningitis. E. A 58-year-old experiencing ETOH withdrawal.

The answers are A, B, D, and E. All the patients are at risk except option C. Remember all the risk factors: illness (especially CNS types like bacterial meningitis), fever, electrolyte/metabolic issues (low blood sugar, acidosis etc), ETOH (alcohol) withdraw, brain injury, STROKE, congenital brain defects, tumors etc.

Patients with COPD need to converse their ____________.

energy

Why would a patient with Meniere's disease be prescribed antihistamines and diuretics?

To reduce fluid with the ear Reduces vertigo, tinnitus, and fullness feeling in the ear.

Causes stiffening of the muscles/joints

Tonic

What is the #1 priority when caring for a patient with migraine headaches?

Treating the pain

How are acute seizures treated? (Acute seizures are greater intensity, number, or length than the patient's usual seizures. They may also appear in clusters that are different from the patient's typical seizure pattern)

Treatment with lorazepam (Ativan) or diazepam (Valium) may be given to stop the clusters to prevent the development of status epilepticus. IV phenytoin (Dilantin) may be added

Medications are given for Parkinson's to prolong progression. Not to cure. True or false.

True

What are some signs of hearing loss?

Turning the head straining to hear Asking a question to be repeated several times Ignoring phone or doorbell rings Ignoring questions Responding incorrectly Increases volume on electronic devices Withdrawing from social activities Speaking loudly Physical symptoms: pain, headache, & fever

What is a MAJOR risk factor of a stroke?

Uncontrolled hypertension (other risks: family history of HTN, cocaine use, Dx of an aneurysm, Hyperlipidemia, Diabetes, Obesity, smoking, Afib, alcoholism, sickle cell disease)

When teaching a patient who will be receiving antihistamines, the nurse will include which instructions? (Select all that apply.) a. "Avoid activities that require alertness until you know how adverse effects are tolerated." b. "Drink extra fluids if possible." c. "Take the medication with food to minimize gastrointestinal distress." d. "Antihistamines are generally safe to take with over-the-counter medications." e. "Antihistamines may cause restlessness and disturbed sleep." f. "Take the medication on an empty stomach to maximize absorption of the drug."

a. "Avoid activities that require alertness until you know how adverse effects are tolerated." b. "Drink extra fluids if possible." c. "Take the medication with food to minimize gastrointestinal distress."

As the nurse you are providing care for a client who has a diagnosis of macular degeneration. Which of the following foods should the nurse recommend for this client? Select all that apply. a. Sweet potatoes b. red meat c. chicken d. broccoli

a. Sweet potatoes d. broccoli

A nurse is in a client's room when the client begins having a tonic-clonic seizure. Which of the following actions should the nurse take first? a. Turn the client's head to the side. b. Check the client's motor strength. c. Loosen the clothing around the client's waist. d. Document the time the seizure began.

a. Turn the client's head to the side.

The nurse is managing a client with new-onset seizure activity and is to provide phenytoin. The nurse should be aware that Phenytoin a. causes tissue vesication if infiltrated b. has the most rapid onset of action of seizure medications c. must be administered in dextrose d. administration can result in hypertension

a. causes tissue vesication if infiltrated

When is a person with TB contagious?

an infected person is not contagious to others until symptoms of disease occur.

After surgery to correct retina detachment, patient needs to call MD if what occurs?

any pain, N&V, or decrease in vision Patch will need to be worn to protect eye from retearing

Sensation of feeling or visualization they get right before migraine begins

aura

A nurse is caring for a client who who has had a stroke involving the right hemisphere. Which of the following alterations in function should the nurse expect? a. Difficulty reading b. Inability to recognize his family members c. Right hemiparesis d. Aphasia

b. Inability to recognize his family members The right hemisphere is involved with visual and spatial awareness.

A male client has been experiencing seizures and is in the hospital for tests. While in the hospital setting, the client experiences a seizure. Which of the following should the nurse do? a. Restrain the client's arms and legs. b. Take measures to prevent injury. c. Place a tongue blade in the client's mouth. d. Elevate the head of the bed.

b. Take measures to prevent injury.

What is a benefit of a dopamine agonsit?

fewer incidents of dyskinesia (involuntary movements of face, arms, legs or trunk)

What are 2 late signs of glaucoma?

halos, and loss of peripheral vision

What are some triggers that can cause migraines?

caffeine foods with MSG (chinese food) hormones stress red wine

During an episode of status asthmaticus, what does it mean when the wheezing suddenly stops?

complete airway obstruction trach is needed

What is a late sign of asthma?

cyanosis also, change of LOC

The nurse is performing patient education regarding medications used to prevent migraines. Which of the following medications should the nurse explain as potential treatments? a. Anti-seizure drugs b. Anti-depressant drugs c. Beta-blockers d. All of these

d. All of these

A nurse is caring for a client who has Parkinson's disease and is taking diphenhydramine 25 mg PO TID. Which of the following therapeutic outcomes should the nurse expect to see? a. Delay in disease progression b. Improved bladder function c. Relief of depression d. Decreased tremors

d. Decreased tremors

What is the first sign of intracranial pressure?

decreased LOC

What are symptoms of rising intracranial pressure?

vomiting and bad headaches

What lung sounds would you expect to hear in a patient having an acute asthma attack?

wheezing

In a patient suspected of a stroke, how quickly do you want to assess them when arriving in the ER?

within 10 minutes