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Neurological, Eye, Ear

Question
Glaucoma is often painless and symptom-free. It is usually picked up as part of a regular eye exam
Eye drops are used to cause pupil constriction since movement of the muscles to constrict the pupil also allows aqueous humor to flow out, thereby decreasing the pressure in the eye. Pilocarpine is often used. Caution client that vision may be blurred 1
to 2 hours after administration of pilocarpine and adaptation to dark environments is difficult because of papillary constriction (desired effect of the drug).
There is an increased incidence of glaucoma in the elderly population. Older clients are prone to problems associated with constipation. Therefore, the nurse should assess these clients for constipation and postoperative complications associated with co
constipation, and implement a plan of care directed at prevention, and, if necessary, treatment for constipation
The lens of the eye is responsible for projecting light, which enters onto the retina so that images can be discerned. Without the lens, which becomes opaque with cataracts, light cannot be filtered and vision is blurred
When the cataract is removed, the lens is gone, making prevention of falls important. If the lens is replaced with an implant, vision is better than if a contact lens is used (some visual distortion) or if glasses are used (greater visual distortion – ev
The ear consists of three parts: the external ear, the middle ear, and the inner ear. Inner ear disorders, or disorders, or disorders of the sensory fibers going to the CNS, often are neutrogenic in nature and may not be helped with a hearing aid. Exter
External and middle ear problems (conductive) may result from trauma or wax buildup. These types of disorders are treated more successfully with hearing aids.
NCLEX-RN questions often focus on communicating with older adults who are hearing impaired
• Speak in a low-pitched voice, slowly, and distinctly.
• Stand in front of the person with the light source behind the client.
• Use visual aids if available
Use the Glasgow Coma Scale eliminates ambiguous terms to describe neurologic status such as lethargic, stuporous, or obtunded.
Almost every diagnosis in the NANDA format is applicable, as severely neurologically impaired persons require total care
Clients with an altered state of consciousness are fed by NG tube since the likelihood of aspiration with oral feedings is great. Residual feeding is the amount of previous feeding in the small stomach.
The presence of 100ml residual in adults usually indicates poor gastric emptying and the feeding should be held
Paralytic ileus is commonin comatose clients. NG tube aids in gastric decrompression
Any client on bedrest/immobilized must have range of motion exercises pften and very frequent position changes. Do not leave the client in any one position for longer than 2 hours.
Any position that decreases venous return is dangerous, i.e., sitting with dependent extremities for long periods
If temperature elevates, take quick measures to decrease it since fever increases cerebral metabolism and can increase cerebral edema
Safety Features for Immobilized Clients: • Prevent skin breakdown with frequent turning
• Maintain adequate nutrition
• Prevent aspiration with slow, small feedings or NG feedings
• Monitor neurological signs to detect the first, signs that intracranial pressure may be increasing
• Provide range of motion exercises to prevent deformities
• Prevent respiratory complications – frequent turning and positioning for optimal drainage.
Restlessness may indicate a return to consciousness but can also indicate anoxia, distended bladder, covert bleeding, or increasing cerebral anoxia. Do not over-sedate, and report any symptoms of restlessness.
The forces of impact influence the type of head injury. They include acceleration injury, which is caused by the head in motion, and deceleration injury, which occurs when the head suddenly stops. Helmets are a GREAT preventive measure for motorcycles a
Even subtle behavior changes, such as restlessness, irritability, or confusion, may indicate increased ICP.
CSF leakage carries the risk of meningitis and indicates a deteriorating condition. Because of CSF leakage, the usual signs of increased ICP may not occur
TRY NOT to use restraints; they only increase restlessness. AVOID narcotics since they mask level of responsiveness
TRY NOT to use restraints; they only increase restlessness. AVOID narcotics since they mask level of responsiveness
It is imperative to reverse spinal shock as quickly as possible. Permanent paralysis can occur if a spinal cord is compressed for 12 to 24 hours
A common cause of death after a spinal cord injury is urinary tract infection. Bacteria grow best in alkaline media, so keeping urine dilute and acidic is prophylactic against infection. Also, keeping the bladder emptied assists in avoiding bacterial gr
Benign tumors continue to grow and take up space in the confined area of the cranium causing neural and vascular promise for the brain, increased intracranial pressure, and necrosis of brain tissue – even benign tumors must be treated as they may have mal
Craniotomy preoperative medications:• Corticosteroids to reduce swelling, • Agents and osmotic diuretics to reduce secretions (atropine, robinul• Agents to reduce seizures (phenytoin• Prophylactic antibiotics
Symptoms involving tumor function usually begin in the upper extremities with weakness progressing to spastic paralysis. Bowel and bladder dysfunction occurs in 90% of the cases. MS is more common in women. Progression is not “orderly
Drug therapy for MS clients: ACTH, cortisone, Cytoxan, and other immunosuppressive drugs. Nursing implications for administration of these drugs should focus on prevention of infection.
In clients with Myasthenia Gravis, be alert for changes in respiratory status – the most severe involvement may result in respiratory failure
Bedrest often relieves symptoms. Bladder and respiratory infections are often a recurring problem. Need for health promotion teaching
Myasthenic crisis is associated with a positive edrophonium (Tensilon) test, while a cholinergic crisis is associated with a negative test.
NCLEX-RN questions often focus on the features of Parkinson’s disease – tremors (a coarse tremor of fingers and thumb on one hand which disappears during sleep and purposeful activity – also called “pill-rolling”), rigidity, hypertonicity, and stooped pos
posture. Focus: SAFETY!
An important aspect of Parkinson’s treatment is drug therapy. Since the pathophysiology involves an imbalance between acetycholines and dopamine, symptoms can be controlled by administering dopamine precursor (Levadopa).
CNS involvement related to cause of CVA:• Hemorrhagic – caused by a slow or fast hemorrhage into the brain tissue – often related to hypertension
• Embolytic – caused by a clot, which has broken away from some vessel and has lodgedin one of the arteries of the brain, blocking the blood supply. It is often related to atherosclerosis (may happen again).
Atrial flutter/fibrillation has a high incidence of thrombus formation following arrhythmia due to turbulence of blood flow through all valves/heart chambers
A woman who had a stroke two days ago has left-sided paralysis. She has begun to regain some movement in her left side. What can the nurse tell the family about the client’s recovery period?
“The quicker movement is recovered, the better the prognosis is for more or full recovery. She will need patience and understanding from her family as she tries to cope with the stroke.
Mood swings can be expected during the recovery period, and bouts of depression and tearfulness are likely
Words that describe losses for CVA
• Apraxia: inability to perform purposeful movements in the absence of motor problems • Dysarthria: difficulty articulating • Dysphagia: inability to speak or understand words
• Aphasia: loss of the ability to speak • Agraphia: loss of the ability to write • Alexia: loss of the ability to read • Dysphagia: dysfunctional swallowing.
Steroids are administered after a stroke to decrease cerebral edema and retard permanent disability. H2 inhibitors are administered to prevent peptic ulcers
Created by: Daverica