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Adult Health I Ex2
Exam 2 Study Guide
| Term | Definition |
|---|---|
| Eye Inflammation/Infection | Caused by microorganisms, such as bacteria, fungus, virus, irritants |
| Eye Inflammation/Infection | If due to irritants, irrigate the eye Eye wash station or Morgan Lens at the hospital |
| Eye Inflammation/Infection | If patient has infection, such as conjunctivitis, use antibiotic eye drops Educate patient not to let the tip of the dropper touch their eye cause the infection can spread |
| Characteristics of Inflammation/Infection | Redness of eye Discharge from eye Patient feels like they have a foreign body in their eye (possible corneal abrasion) Itchiness of the eye |
| Characteristics of Inflammation/Infection | Blurry vision (ask if vision is usually blurry or if it is new onset to establish a baseline) *ONLY SEEN IN INFLAMMATION* |
| Increased Intraocular Pressure (IOP) | Normal IOP is 10-21 mmHg Tonometry (Tono Pen) used to measure IOP During exam, ensure patient avoids squeezing their eyelids, holding their breath, and doing the Valsalva maneuver because they can increase IOP temporarily |
| Increased Intraocular Pressure (IOP): Causes | Caused by glaucoma |
| glaucoma | a group of ocular conditions in which damage to the optic nerve is related to IOP caused by congestion of the aqueous humor Incidence increases with age Risk factors of cardiovascular disease, diabetes, thin cornea, older age |
| glaucoma | also known as “silent thief” because patients may not exhibit any symptoms until loss of vision Some may complain of achy sensation in their eye Patients may complain of tunnel vision |
| glaucoma | Can prescribe Cholinergics (Miotics) or Beta blockers (Timolol) Timolol can cause systemic effects, so monitor HR and BP |
| Glaucoma: Treatment effectiveness | Monitor their vision and assess for any changes in visual field Monitor IOP Ensure patient is compliant with medication and knows how to properly use eye drops Provide support and interventions to help patients adjust to vision loss |
| Blind patient: Nursing interventions | Legally blind is visual acuity of 20/200 Complete blindness is visual acuity of 20/400 |
| Blind patient: Nursing interventions | Orient patient to environment to promote safety Ensure they know where their call light is Ensure they know how to contact their nurse, PCA Let them know where the things in their room are |
| Blind patient: Nursing interventions | Encourage independence Use clock method for feeding (i.e. chicken is at the 12 o’clock) |
| Cataracts | medical disorder where patients may have cloudiness or opacity of the lens Incidence increases with aging (>80 years old, 50% diagnoses with cataracts) Leading cause of disability in the U.S. |
| Cataracts | Some cases may have minimal symptoms, but if they have reduced vision that interferes with regular activity, they need surgery Surgery is performed on an outpatient basis with local anesthesia Takes less than 1 hour, discharged soon after |
| Cataracts Post-op issues | Need someone to pick them up and drive them home Notify HCP if any complaint of pain in eye for evaluation |
| Cataracts Post-op Risks | acute bacterial infection that can cause pain Inflammation in their eye that can cause pain Always a risk, so may be prescribed corticosteroid drops to help reduce inflammation Suture related issues |
| Cataracts Nursing Interventions | Provide written and verbal instructions Wash hands before and after administering corticosteroids |
| Cataracts Teaching | Call HCP immediately if: any vision changes occurs continuous flashing light appears Redness Swelling Increased pain Amount of drainage increases Pain not relieved by tylenol |
| Cataracts Teaching | Educate about how and when to use drops Wash hands before and after administering corticosteroids Advise patients to avoid laying on the side of the affected eye after surgery Educated to wear eye shield at night for the first night to avoid injury |
| Cataracts Teaching | Keep activity light and avoid lifting, pushing, or pulling objects heavier than 15 pounds Be cautious climbing stairs Sneeze with mouth open (if closed, can increase IOP) Educated to take antibiotics, if ordered |
| Cataracts Teaching | Resume following activities only if approved by ophthalmologist: Driving Sexual activity Unusually strenuous activity |
| Retinal Detachment | medical emergency, when there is separation of the sensory retina and the retinal pigment epithelium Will need surgery (maybe a scleral buckle) to preserve their eye and vision |
| Retinal Detachment Signs and symptoms | *Sensation of a shade or curtain closing over the vision of one eye* May see bright flashing lights May have sudden onset of floaters |
| Ear drop administration | May be prescribed for external otitis or acute otitis media Instill drops without dropper touching the ear to prevent infection from getting on the dropper Wash hands before and after administering |
| Acute otitis media | more frequently seen in children May have fever, ear pain, hearing loss May take oral antibiotics in some cases |
| Auditory system: Age related changes | 50% of patients >70 years old may have some form of hearing loss Presbycusis: increased incidence of hearing loss due to age Risk factor is exposure to excessive noise levels |
| Webber and Rinne Tests: Cranial nerve | Help determine if hearing loss is conductive or sensorineural Test the acoustic nerve (CN VIII) in the inner ear Helps with hearing and equilibrium (balance) |
| Webber test | uses bone conduction to assess hearing status Tuning fork is placed on top of the head |
| Webber test | Normal hearing, sound is heard equally in both ears conductive hearing loss, sound is heard best in affected ear Sensorineural hearing loss, sound is heard best in normal hearing ear |
| Rinne test | uses bone and air conduction to assess hearing status Tuning fork is placed on the mastoid (bone) and then off the ear (air) |
| Rinne test | Normal hearing, air conduction > bone conduction in both ears Conductive hearing loss, sound is heard longer in affected ear Sensorineural hearing loss, air conduction > bone conduction in affected ear |
| Hearing loss: Signs and symptoms | Tinnitus Assess if they take aspirin daily Increased inability to hear in social settings Report that they are turning the volume up louder to hear properly May answer questions inappropriately (i.e. ask you to repeat the question a few times) |
| As hearing loss increases patients may experience: | Deterioration of speech Fatigue Indifference Social isolation/withdrawal (educate them on coping strategies and social support) |
| Hearing loss: Communication techniques | Patients have a decreased ability to hear high pitched sounds, so make sure you are speaking to them in a normal tone of voice Involve patient in their care, so still provide verbal instructions along with written instructions |
| Hearing loss: Communication techniques | Speak to patients in their better ear (i.e. if right sided hearing loss, speak in their left ear) Answer all questions related to education to make sure they understand their teaching |
| Hearing loss: Communication techniques | Reduce background noise and distractions Use gestures and facial expressions Speak to patient while facing them so they can read your lips |
| Deaf patient: Nursing interventions | Ensure patient is aware of environment May need to write out info for them, they may write back If patient uses sign language, have an interpreter present Talk to them while facing them so they can read your lips and understand your hand gestures |
| What is affected in Conductive Hearing Loss | Caused by problem in middle or outer ear Sound has trouble going from middle ear to inner ear due to otosclerosis or otitis media Otosclerosis: condition that causes abnormal bone growth within the smaller bones within the middle ear |
| What is affected in Sensorineural Loss | Damage to the cochlear or vestibulocochlear nerve (inner ear) |
| Presbycusis (age related hearing loss)- Discharge teaching | Use a low tone in a normal voice Speak slowly and distinctly Reduce background noise and distractions Face patient to get their attention |
| Presbycusis (age related hearing loss)- Discharge teaching | Speak in the less affected ear Use gestures and facial expressions Write out education to make sure they have printed out discharge instructions |
| Mastoid surgery: Goals | Reduction of anxiety Freedom of pain and discomfort Prevention of infections Stable or improved hearing and communication Absence of vertigo and related injury Increased knowledge of the disease, procedure, and postoperative care |
| Mastoidectomy | removal of the disease mastoid air cells and cholesteatoma (a benign tumor or ingrowth of skin that causes persistently high pressure in the middle ear) to create a noninfected, healthy ear |
| Mastoidectomy | may be needed for chronic otitis media, which usually occurs from recurrent acute otitis media Cholesteatoma may cause hearing loss, neurologic disorders, and destroy the structures of the ear |
| Tympanoplasty | surgical resection of the tympanic membrane most common procedure for chronic otitis media |
| Tympanoplasty: Post op | Avoid heavy lifting (no more than 10 pounds), straining, bending, and nose blowing for 2-3 weeks after surgical procedure to prevent any damage to tympanic membrane Any of the above will increase pressure and cause tympanic membrane to rupture |
| Tympanoplasty: Post op | Take antibiotics and medications as prescribed May feel a popping or crackling sensation in the operative ear, but is normal and lasts 3-5 weeks after surgery |
| Tympanoplasty: Post op | Avoid getting water in operative ear for at least 2 weeks Place a cotton ball in their ear to prevent water from getting in when showering |
| Meniere’s Disease | abnormality in the inner ear fluid balance caused by a malabsorption of the endolymphatic sac or blockage of the endolymphatic duct |
| Meniere’s Disease: Manifestation | Episodic vertigo Tinnitus Fluctuating sensorineural hearing loss May feel pressure in ear Nausea vomiting |
| Meniere’s Disease: Assessment | If patient has vertigo or dizziness, promote safety Do not have them get up and walk to the bathroom, so offer bedpan to avoid falls |
| Meniere’s Disease: Treatment | May do surgical management to help with attacks of vertigo Endolymphatic sac decompression Middle and inner ear perfusion Vestibular nerve sectioning |
| Meniere’s Disease: Diet | Encourage low sodium diet (1,000-1,500mg sodium daily) Water follows sodium! |
| Meniere’s Disease: Treatment | May be prescribed valium, which is a tranquilizer May be prescribed promethazine, which is an antiemetic May be prescribed diuretics because of imbalance of fluid in ear May be prescribed meclizine (antivert) to help with vertigo |
| Hypertension | “silent killer”, most common disease in U.S. adults |
| What blood pressure range is considered hypertensive? | Normal BP: systolic BP <120/ diastolic BP <80 Elevated BP: systolic BP 120-129/ diastolic BP <80 Stage 1 HTN: systolic BP 130-139/ diastolic BP 80-89 Stage 2 HTN: systolic BP >140/ diastolic BP >90 |
| What do we want to teach our patients about hypertension? | If diagnosed with HTN and develop any symptoms of headache, dizziness, blurred vision, or chest pain, seek medical attention IMMEDIATELY. Advise them to comply with their medications and have an understanding of their BP and HR parameters |
| What do we want to teach our patients about hypertension? | Educate them about signs and symptoms and risk of developing the following: cerebral vascular disease renal insufficiency (renal disease) retinal hemorrhage myocardial infarction |
| What do we want to teach our patients about hypertension? | Educate them about their diet: Avoid/limit sodium intake Avoid consumption of saturated fat |
| What do we want to teach our patients about hypertension? | Encourage patients to take medications daily, unless BP or HR reading is below a certain range (range is previously discussed with their HCP to determine when to hold medication) |
| Hypertension medication: Beta blockers- Metoprolol | Affects the HR and BP Monitor HR and BP to ensure they are within range before administering Notify doctor if BP reading is low in a clinical setting |
| Hypertension medication: Diuretics- Furosemide (Lasix) | Affects the BP Monitor BP prior to administering Encourage compliance, despite side effect of frequent urination Notify HCP for any concerns |
| Hypertension medication: Ace inhibitors- Lisinopril | Affects HR and BP Monitor vital signs right before administering Severe adverse reaction is angioedema (facial and mouth swelling) so PRIORITY IS MAINTAINING A PATENT AIRWAY |
| Hypertension Modifiable risk factors | Smoking Diet high in sodium Diet high in saturated fat Obesity Physical inactivity Dyslipidemia Microalbuminuria GFR <60 |
| Hypertension Nonmodifiable risk factors | Older age Family history HTN |
| What is the plan of care for hypertension patient? | Control BP, but can be difficult if they are unaware they have HTN Educate them on medication compliance Educate about importance of diet (low sodium and low saturated fat) and exercise Educate to prevent complications and further risks |
| What are some complications of hypertension? | No signs/symptoms, but if left untreated: Aneurysm Stroke Abdominal aortic aneurysm (AAA) dissection Cerebral vascular disease Renal insufficiency (renal disease) Retinal hemorrhage |
| What are some complications of hypertension? | No signs/symptoms, but if left untreated: Myocardial infarction Heart failure (due to left ventricle pushing hard to pump blood out to meet peripheral resistance) |
| What are some complications of hypertension? | No signs/symptoms, but if left untreated: Distended jugular vein (indication of right sided heart failure) Left side of heart fails first leading to right side of heart to fail causing fluid backup |
| Masked hypertension | Elevated BP reading in home settings, but readings can be normal at doctor’s office Elevated in home settings due to patient activity: Running errands Doing chores Drinking coffee |
| Masked hypertension | Still required to ask if they have any symptoms of headache, dizziness, blurred vision, or chest pain |
| White coat hypertension | Elevated BP readings when they see a HCP at a doctor’s office or hospital, but readings are normal at home Still required to ask if they have any symptoms of headache, dizziness, blurred vision, or chest pain |
| Hypertensive Emergency | BP reading systolic >180/ diastolic >120 Evidence of damage to target organs Reduce BP to 160/100 within the next 2-6 hours Gradually continue to reduce BP to normal within 24-48 hours IV medications usually given |
| Hypertensive Emergency | Reduce BP by no more than 25% in the FIRST hour to prevent further organ damage Since patients have had HTN, their organs are used to being perfused at a certain pressure |
| Hypertensive Emergency | Frequently monitor BP, HR, cardiovascular status Notify HCP of any severe changes IMMEDIATELY |
| Hypertensive Urgency | BP reading systolic >180/ diastolic >120 Does not have any evidence of organ damage Can take oral medication, since no evidence of any organ damage Labetalol Clonidine |
| Hypertensive Urgency | Frequently monitor BP, HR, cardiovascular status to make sure urgency does not lead to an emergency Notify HCP of any severe changes IMMEDIATELY |
| In hypertension, assess for organ damage by: | Monitoring lab values (BUN, creatinine) Assess for signs of retinal hemorrhage Assess for signs of stroke |
| Monitoring BP | Use the correct size cuff Ensure patient’s legs are not crossed Encourage patient to take deep breaths when cuff gets tight or uncomfortable Ask patients if they have any symptoms of headache, dizziness, blurred vision |
| Monitoring BP | Encouraged to have more than 1 BP reading because initial reading can be inaccurate due to pain, anxiety, stress, or diet |
| Monitoring BP at discharge | Notify HCP if patient has elevated BP reading at discharge Always notify HCP of abnormal vital signs to promote safety |
| Monitoring BP at discharge | If patient is supposed to take a medication at home, but BP reading is elevated at discharge, the provider may want to monitor them or give them a dose of medication before they go home |
| Dyslipidemia | unbalanced and unusually elevated blood cholesterol (fatty substance manufactured in the liver that is carried throughout the body in the blood stream- LDL, HDL, triglycerides) |
| What should we include in our patient teaching for dyslipidemia? | Generally no symptoms until progression leads to further complications: Stroke Atherosclerosis Myocardial infarction |
| What should we include in our patient teaching for dyslipidemia? | Educate them about ways to lower their cholesterol or lipids Consume LESS saturated fats, consume MORE monounsaturated and polyunsaturated fats Exercise at least 30 mins a day Smoking cessation |
| What should we include in our patient teaching for dyslipidemia? | Encouraged to start with diet modifications (less saturated fats), losing weight, exercise BEFORE being prescribed medication If lifestyle modifications do not work, then consider statin or nonstatin medications |
| What are the modifiable risk factors for Dyslipidemia | Smoking Obesity *increases risk of dyslipidemia* Diabetes *increases risk of dyslipidemia* Diet |
| Nonmodifiable risk factors for Dyslipidemia | Genetics |
| Diagnostic tests to perform for dyslipidemia | Order lipid panel, patient should be fasting (do not eat 8-12 hours prior to blood draw) |
| Diagnostic tests to perform for dyslipidemia | HDL is good cholesterol that prevents LDL from sticking to arterial walls, preventing atherosclerosis LDL is bad cholesterol that causes plaque buildup Triglycerides, elevated levels put patients at risk for heart disease and diabetes |
| Diagnostic tests to monitor for dyslipidemia | HDL should be >90 LDL should be <100 Triglycerides should be <150 |
| Medication to treat dyslipidemia: Statins | Statins (simvastatin, atorvastatin) prevent cardiovascular and cerebrovascular events |
| Statins Contraindications | Active or chronic liver disease pregnancy |
| Statins Severe Adverse Reactions | Myopathy (muscle aches), NOTIFY HCP ASAP and may discontinue Right upper quadrant pain (could indicate enlargement of liver), NOTIFY HCP ASAP and may discontinue |
| Statins Monitoring | Notify HCP about abnormal liver function test Assess for RUQ pain and myopathy |
| Medications to treat dyslipidemia: Nonstatins | work differently than statins |
| Nonstatins Side Effects | GI upset (upper GI complaints of nausea, belching), notify HCP |
| Nonstatins Monitoring | Monitor for GI complaints Notify HCP about abnormal liver function test |
| Medications to treat dyslipidemia: omega-3 fatty acids (fish oil) | can be taken OTC |
| omega-3 fatty acids (fish oil) Containdications | Pregnancy (can contain high levels of mercury) |
| omega-3 fatty acids (fish oil) Monitoring | Notify HCP about abnormal liver function test |
| Nursing assessment of venous disorders. | Skin should be warm to touch, not cool Inspect for areas lacking in hair growth Palpate peripheral pulses (popliteal, dorsalis pedis, posterior tibial) |
| Diagnostic Exams to perform for venous disorders. | Doppler ultrasound flow study Ankle- brachial index (compare BP in upper extremities compared to lower extremities to see if patient has peripheral arterial disease) |
| Diagnostic Exams to perform for venous disorders. | Blood test to monitor homocysteine levels (elevated levels can indicate coagulation and increase risk of clots) |
| Diagnostic Exams to perform for venous disorders. | If assessing an extremity and unable to feel for a pulse, use a doppler If cannot assess pulse with doppler, notify HCP for an ultrasound because can indicate medical emergency |
| PAD, Atherosclerosis, DVT, & Varicose Veins | Educate patients about changing their modifiable risk factors to prevent these vascular disorders. |
| Risk factors for PAD | Hypertension Diabetes Obesity Stress Dyslipidemia |
| Risk factors for Atherosclerosis | Dyslipidemia Diabetes Obesity Stress Lifestyle |
| Risk factors for DVT | Increased levels of homocysteine Patients on bed rest with limited mobility Patients on oral contraceptives Nicotine use Smoking Patients who recently have been sitting on a long trip Receiving surgery |
| Risk factors for DVT | Patients will receive preventative treatment if they stay in a hospital: Encourage early ambulation May be prescribed sequential devices Massagers that go on the legs to constrict blood flow and prevent blood pooling |
| Risk factors for DVT | If patient stays in hospital: May be given heparin injections or lovenox (enoxaparin Monitor catheters because they can damage vessels and put patients at risk of clots |
| Risk factors for DVT | Assess patient’s risk of developing DVT in hospital settings Not necessarily due to immobility, but can be due to older coagulation factors, such as increased homocysteine levels, polycythemia (abnormal increase in rbcs), or Factor V Leiden |
| Risk factors for Varicose veins | Extended standing or sitting Genetics of weak veins Lifestyle Immobility History of developing spider veins |
| Plan of care for patients with PAD (chronic illness that occurs overtime). | Hallmark symptom is intermittent claudication (aching, cramping, inducing fatigue or weakness in their extremities) Brought on by exercise or activity |
| Plan of care for patients with PAD (chronic illness that occurs overtime). | Smoking cessation Reduce stress Encourage brisk exercise to help with altered tissue perfusion Early stages, relieved by rest (sitting position) |
| Plan of care for patients with PAD (chronic illness that occurs overtime). | As disease progresses, may have rest pain (worse at night and wakes up patient) Have patient sit up and dangle legs off the bed to relieve pain |
| Plan of care for patients with DVT. | Ensure patients are receiving their proper medication Ask if they are developing any chest pain or shortness of breath (can indicate pulmonary embolism) Prevent venous stasis Assess if patient has altered coagulation |
| Plan of care for patients with DVT. | If at risk of DVT, use preventative measures such as VTE prophylaxis Lovenox (enoxaparin) Heparin Frequent ambulation, if possible |
| Plan of care for patients with varicose veins. | Encourage exercise, at least 3x weekly Educate patients to wear compression stocking Educate overweight patients on weight reduction plans |
| Plan of care for patients with varicose veins. | Regularly monitor patients to ensure they are following their plan of care because if patients are not adhering to plan, they are at risk of developing gangrene and ulcers *MEDICAL EMERGENCY because can develop sepsis or other infections* |
| Plan of care for patients with varicose veins. | Advise patients to avoid injury If varicose vein ruptures, will be hard to stop bleeding, so go to emergency room |
| Plan of care for patients with Raynaud’s. | Intermittent arterial vasal occlusion, usually affecting finger tips or toes Episodes usually brought on by a trigger, such as cold or stress Encourage patient to wear gloves if going outside during the winter to prevent symptoms |
| Plan of care for patients with Raynaud’s. | Usually most common in women under 30 (5x more likely to develop Raynaud’s) Protect from cold, stress, caffeine |
| Patient assessment of vascular disorders | Assess pulses Assess for sensation Ask patients if they have any pain with exercise or pain with rest Any pain in extremities? Loss of hair or dry skin in the area |
| Treatments of vascular disorders | Blood thinning medications, especially if at risk of developing DVT Encourage lifestyle modifications Smoking cessation Exercise Diet encourage atherosclerosis patients to eat more lean meats and vegetables |
| Patient Teaching of vascular disorders | Encourage lifestyle modifications and exercise Educate on when to seek medical attention if they have varicose veins, to prevent complications of ulcers or gangrene If they have cramping in their legs Report any new symptoms |
| Complications- DVT | Prevent DVT by promoting exercise Ask if they have any DVT risk factors |
| Complications- Ulcers | Assess for ulcers in patients with decreased circulation Monitor patients with varicose veins to prevent ulcers Ask if they have any varicose veins risk factors |
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