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sensory part 2
test 3
| Question | Answer |
|---|---|
| glaucoma is | increased intraocular pressure over a period of time |
| glaucoma causes | atrophy of retinal cells and optic nerve |
| glaucoma leads to | blindness |
| glaucoma pt's are usually over | 40 |
| glaucoma-- vision can be preserved if | detected early and controlled medically |
| glaucoma assessment and diagnostic findings | establish diagnostic category *assess the optic nerve damage *formulate a treatment plan |
| Four major types of exams are used in evaluation, diagnosis, and management of glaucoma | *IOP measurement *optic nerve inspection* examination of the filtration angle of the anterior chamberassesment *Assessment of the visual fields |
| medical management for glaucoma | lifelong therapy is almost always necessary- cannot be cured *Tx focuses on pharmacologic therapy, laser procedures, surgery, or a comboof these approaches |
| glaucoma goals | to prevent optic nerve damage *aim for the greatest benefit with the least risk and cost |
| glaucoma pharmacologic therapy Cholinergics (miotics)- | medications that cause the pupil to contract ~Pilocarpine ~Carbachol |
| glaucoma pharmacologic therapy Carbonic anhydrase inhibitors | ~Atazolamide ~Methazolamide ~Dorzolamide |
| Cholinergics (miotics)- ACTION: | increase aqueous fluid outflow by contracting the ciliary muscle and causing miosis (contriction of the pupil) and opening of the trabecular meshwork |
| Cholinergics (miotics)- SIDE EFFECTS | Periorbital pain, blurry vision, diffiulty seeing in the dark |
| Cholinergics (miotics)- Nursing IMPLICATIONS | caution patients about diminished vision in dimly lit areas |
| Carbonic Anhydrase Inhibitors ACTION: | decreases aqueous humor production |
| Carbonic Anhydrase Inhibitors SIDE EFFECTS: | oral meds (acetazolamide and methazolamide)are associated with serious side effects such as anaphylaxis, electrolyte loss, depression, lethargy, GI upset, impotence, weight loss. *Topical med (dorzolamide) is associated with topical allergy |
| Carbonic Anhydrase Inhibitors IMPLICATIONS: | do not admin. to pt's with sulfa drug allergies, monitor electrolyte levels |
| Glaucoma nursing management Teach: | teach pt's that med and surgery only slow the progression-there is no cure, so it is of utmost importance to follow the regimens prescribed *medications can cuase adverse effects if used improperly-must be used as prescribed, not when eyes feel irritated |
| teach Glaucoma pt's to avoid _____ , as this can cause a severe increase in IOP | antihistamines |
| Macular degeneration | *characterized by tiny, yellowish spots called drusen beneath the retina *cental vision is generally the most affected *two types "wet" and "dry" |
| Macular degeneration medical management | Photodynamic therapy (PDT)- a photosensitive dye is infused IV over 10 minutes, the a diode laser is used to activate the dye, leading to the closure of the vessels |
| Macular degeneration patient teaching | will benefit from bright lighting, magnification devices *amsler grids are often sent home with the pt.- should look at the grid several times a week- if lines are crooked or distorted, pt should notify ophthalmologist immediatley |
| Macular degeneration usually affects _____ vision? | |
| Conductive hearing loss | usually results from an external ear disorder, such as impacted cerumen or a middle ear disorder, such as otitis media (fluid in middle ear accompanied by s/s of infection) or otosclerosis |
| otosclerosis | condition characterized by chronic deafness, esp for low tones-caused by formation of spongy bones, more common in women, may worsen with pregnancy |
| Conductive hearing loss | transmission of sound by air to the inner ear is interrupted |
| conductive hearing loss risk factors | use of ototoxic drugs (aminoglycosides, gentamicin, loop diuretics) *recurrent ear infections |
| conductive hearing loss nursing management | speak into less impaired ear *use gestures and facial expressions *identify practical and effective means of communication *talking in a loud voice to someone who cannot hear high freq. sounds only makes understanding more difficult |
| Transient Ischemic attack (TIA) | brief period of cerebral ischemia that causes neurological deficits lasting for less that 24 hours *warning signs of strokes (CVA's) *caused by temporary impairment of blood flow to a specific region of the brain |
| TIA Encourage follow up care to | prevent further neurological damage |
| Transient Ischemic Attack risk factors | HTN *insulin-dependent diabetes mellitus *caridac disease *Hx of smoking *family hx of stroke *chronic alcoholism |
| TIA clinical manifestations depend on location of affected vessel *interrupted anterior ciculation can result in | fleeting blindness (amaurosis fugax), sudden, painless loss of vision of one eye, aphasia, or contralateral weakness, |
| TIA clinical manifestations: Ischemia in the vertebral basilar system can cause | vertigo, diplopia, numbness, or paresthesia, dysphagia, or ataxia |
| Contralateral weakness | weakness on side of body opposite of brain affected |
| paresthesia | an abnormal or unpleasant sensation that results from injury to one or more nerves, often described by pts as numbness or as a prickly, stinging, or burning feeling |
| TIA assessment | symptoms often sudden and often disappear with in minutes *one sided weakness of hand, arm *aphasia, visual disturbances |
| aphasia | absence or impairment of the ability to communicate through speech, writing, or signs |
| diplopia | two images of an object seen at the same time. (double vision) |
| TIA assessment | symptoms often sudden and often disappear within in minutes *one sided WEAKNESS of hand, arm *aphasia, visual disturbances |
| CVA cerebral vascular accident | an ischemic stroke or "brain attack" *sudden loss of brain func. resulting from a disruption of blood supply to a part of the brain, causing TEMPORARY OR PERMANT loss of MOVEMENT, THOUGHT, MEMORY, SPEECH, or SENSATION |
| Strokes are | hemorrhagic or ischemi/nonhemorrhagic |
| CVA risk factors are the same as TIA | HTN *insulin-dependent diabetes mellitus *cardiac disease *hx of smoking *family hx of stroke *chronic alcholism |
| CVA ischemic strokes are categorized according to their cause: | large artery thrombosis *small penetrating artery throbosis *cardiogenic embolic stroke *cryptogenic *others |
| CVA strokes are also classified by the time course as follows: | *transient ischemic attack *reversible ischemic neurologic deficit *stroke in evolution *completed stroke |
| CVA risk factors: non-modifiable | *age *race *gender |
| CVA modifiable risk | *HTN *atrial fibrillation *high cholesterol *obesity *smoking *diabetes *asymptomatic carotid stenosis |
| CVA clinical manifestations | *numbness or weakness of the face, arm, or leg especially on one side *confusion or change in mental status *trouble speaking or understanding *visual disturbances *difficulty walking, dizziness, or loss of balance or coordination *sudden severe headache |
| CVA Left vs. Right Hemispheric Strokes: Left | Paralysis or weakeness on right side of the body *right visual field deficit *aphasia (expressive, receptive or global) *altered intellectual ability *slow, cautious behavior |
| CVA Left vs. Right Hemispheric Strokes: Right | Paralysis or weakness on left side of body *left visual field deficit *spatical-perceptual deficits *increased distractibility *impulsive behavior and poor judgement *lackof awareness of deficits |
| CVA and TIA common diagnostic test | non-contrast CT of the head and neck-initial diagnostic test *doppler ultrasound *arteriogram |
| CVA-Ischemic Stroke medical management | platelet aggression inhibitors *given when pt has experienced TIAs and stroke from suspected embolic or thrombotic causes |
| CVA-Ischemic Stroke medical management MEDICATION | prescribed is based on pt's health history *aspirin *extended-release dipyridamole (Persantine) plus aspirin (both together are Aggrenox) *Clopidogrel (Plavix) *Ticlopidine (Ticlid) |
| CVA-Ischemic Stroke medical management: Anticoagulant | warfarin sodium (Coumadin) *give as secondary prevention for those with atrial fibrillation or cardioembolic stroke *goal is to keep internation normalized ratio (INR) at 2.5 |
| CVA-Ischemic Stroke medical management: Thrombolytic Therapy | used to treat ischemic stroke by dissolving the blood clot that is blocking blood flow to the brain * |
| CVA-Ischemic Stroke medical management: Thrombolytic Therapy :Recombinant t-PA | is a genteically engineered form of t-PA, a throbolytic substance made naturally by the body |
| CVA-Ischemic Stroke medical management: thrombolytic therapy | Rapid diagnosis of stroke and initiation of thrombolytic therapy within 3 hours in pt's with ischemic stroke leads to decrease in the size of the stroke and an overall improvement in functional outcome after 3 months |
| CVA ischemic stroke: therapy for patients ineligible to receive t-PA may include | anticoagulant therapy (IV heparin or low-molecular weight heparin - Lovenox. *use is no longer recommended for pts with acute ischemic stroke, wheather treated with t-PA or not |
| CVA ischemic stroke careful maintenance of cerebral hemodynamics to maintain | cerebral perfusion |
| CVA ischemic stroke Increased intracrainial pressure (ICP) from brain edema may occur | after a large ischemic stroke |
| CVA ischemic stroke may administer osmotic diuretic (mannitol) to | lower ICP and position to avoid hypoxia |
| CVA ischemic stroke nursing management | Primary complications of carotid endarterectomy are stroke, crainal nerve injuries, infectorin or hematoma at the incision, and carotid artery disruption |
| CVA ischemic stroke nursing management: maintain adequate B/P | hypotension is avoided to prevent cerebral ischemia and thrombosis *uncontrolled hypertesion may precipitate cerebral hemorrhage, edem, hemorrhage at the surgical incision, or disruption of the arterial reconstruction |
| CVA ischemic stroke nursing management | monitor neurologic status freq *assess for new onset of difficulty swallowing, hoarseness or other signs or cranial nerve dysfunction *observe for excessive edema and hematom formation at surgical site- emergency airway supplies, (including tracheostomy ) |
| most common cause of visual loss in ppl older than 60 | Macular degeneration |
| ischemic | loss of oxygen |
| never use TpA for _____ strokes | hemorrhagic |
| hemorrhagic | bleeding |
| CVA hemmorhaggic stroke | bleeding into the brain tissue |
| cva hemorrhagic stroke clinical manifestations | *severe headache and often loss of consciouusness *nuchal rigidity (rigidity of the back and neck)*neurological deficits similar to ischemic strokes |
| immediate complications of cva hemorrhagic stroke | hypoxia and decreased bl flow |
| cva hemorrhagic stroke assessment and diagnostic findings | noncontrast CT to determine size and location and cerebral angiogram |
| cva hemorrhagic stroke prevention | management of HTN, reducing alcohol intake, increase awareness of phenylopropanolamin (PPA an ingredient fornd in appetiete suppressnets, cold meds), increase awareness of hemorrhagic strokes |
| cva hemorrhagic stroke medical management | goals: allow the brain to recover, to prevent or minimize risk for rebleeding, prevent and treat complications *bed rest with sedation to prevent agitation and stress, management of vasospasm, and surg. & med. Tx to prevent rebleeding, |
| for hemorrhagic stroke pt compression devices may be used to prevent | deep vein thrombosis |
| CVA- ischemic and hemorrhagic stroke planning and goals | rehab begins on the 1st day of stroke *goals: improved mobility, avoidance of shoulder pain, achievement of self care, relief of sensory and perceptural deprivation, prevetnion of aspiration, continence of bowel and bladder, improved thought process |
| CVA- ischemic and hemorrhagic stroke planning and goals continued | communication, maintaining skin integrity, restored family func., improved sexual func., and absense of complications |
| to be effective, thrombolytic therapy with t-PA should be given to a nonhemorrhagic stroke pt within what timeframe? | 3 hours |
Created by:
chelsea309
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