NUR2571 Exam 3 Concept Guide Professional Nursing II PN 2.pdf, Exams of Neurobiology

Download NUR2571 Exam 3 Concept Guide Professional Nursing II PN 2.pdf and more Exams Neurobiology in PDF only on Docsity! 1 NUR2571 Exam 3 Concept Guide Professional Nursing II / PN 2 ➢ Cataracts- lens opacity that distorts the image; common with older adults - Early symptoms- slightly blurred vision and decreased color perception. Pt thinks glasses are smudged. - Later symptoms- blurred and double vision occur. Pt has difficulties performing ADL’s - Treatment- surgery is the only cure - Teaching- Antiplatelet drugs (aspririn, Plavix) needs to be d/c’d prior to surgery. call doctor for increased pain, DO NOT bend over from waist, lift anything more than 10 lbs, or perform strenuous activities, and use stool softeners to avoid constipation ➢ Glaucoma- increase in intraocular pressure causing tissue necrosis leading to irreversible blindness. Pt has tunnel vision. Pt has gradual loss of peripheral vision. ➢ - Treatment- Non-surgical: Eye drops are used to reduce the production of or decrease absorption of aqueous humor. It is important to teach to apply punctual occlusion to prevent systemic absorption of eye drop. Oral glycerin and IV mannitol are given for angle-closure glaucoma to rapidly reduce IOP. Surgical: only used when drugs are not effective at controlling IOP. Two common procedures= laser trabeculoplasty and trabeculectomy. - Medications- Prostaglandin Agonist (Latanoprost) drug should not be used if cornea is not intact also teach that medication darkens eye color ; Beta-adrenergic blockers (Carteolol) not for people with asthma or COPD , if pt has DM check BS frequently because they cause hypoglycemia ; Carbonic Anhydrase inhibitors (Brinzolamide) not for pt with allergies to sulfa, teach pt to shake drug before applying. - Diagnostic tests- tomonetry measures IOP normal pressure is 10-21 mm Hg. Visual field testing by perimetry, and gonioscopy determines if angle is open or closed. ➢ Retinal Detachment- separation of the retina from the epithelium. - Symptoms- sudden bright flashes or light (photopsia) or floating dark spots in the affected eye. - Teaching- post-surgical correction of retinal detachment, pt should be taught to avoid activities that cause rapid eye movement like reading and writing. ➢ Macular Degeneration- deterioration of the macula; effects central vision, causing blind spots directly ahead. - Symptoms- patients describe mild blurring and distortion at first & reduced central vision. ➢ Hearing impaired - Medications/ Ototoxic- Meds that cause ototoxicity include Vancomycin, loop diuretics like furosemide, NSAIDs and chemotherapy agents like cisplatin. - Communication- pt may isolate themselves. Social isolation can lead to depression so encourage pt and family to discuss their feelings. Nursing priorities focus on facilitating communication and reducing anxiety. Communicate with pt by using pictures and writing, use assistive devices like hearing aids, lip-reading and sign language can increase communication. - Types of hearing loss and causes: 2 Conductive hearing loss- obstruction of sound wave d/t foreign body obstruction in external canal. Sensorineural hearing loss- defect in the cochlea (8th cranial nerve), or the brain (exposure to loud noise or music damages the cochlear hair leading to hearing loss). Mixed conductive-sensorineural hearing loss- results from both conductive and sensorineural hearing loss. - Meniere’s disease- Endolymphatic fluid that distorts the entire inner-canal that decreases hearing by dilating the cochlear duct, causing vertigo and tinnitus. Occurs in people between 20-50 yr olds. HIGH RISK FOR FALLS!! - Symptoms- Three features: tinnitus, one-sided sensorineural auditory sensory perception loss, and vertigo; headache & fullness of affected ear. - Mastoiditis- Infection of the mastoid air cells caused by progressive otitis media. Untreated middle ear infection progresses to mastoiditis. If mastoiditis is not properly treated, it can lead to brain abscess, meningitis, and death. - Assessment of hearing loss ▪ Different tests- Audioscopy- handheld device used to generate tones of varying intensities to test hearing. ; Weber test- place vibrating tuning fork on the middle of the patient’s head. Pt should equally hear vibration in both ears. ; Rinne- compares hearing by air conduction with hearing by bone conduction (Place tuning fork on mastoid process). Normally sound is heard 2 to 3x’s longer by air then by bone conduction. ▪ Potential symptoms (hearing loss)-tilting head to one side or leaning forward when listening to another person speak; frequently asking speaker to repeat themselves or stating “what?” and “huh?”; pt does not respond to whispered questions; pt is startled when unexpected sound occurs in the environment; pt answer doesn’t match what speaker asked. - Otitis Media- Infection in the middle ear causing inflammation of the mucosa, leading to swelling and irritation of the ossicles, followed by purulent inflammatory exudate. If not treated correctly can cause permanent conductive hearing loss. On examination, eardrum is retracted and redness is present. - Patient teaching- remain current on all immunizations, proper handwashing to minimize infection, complete all abx as prescribed, avoid head trauma. - Aging adult hearing changes Pinna becomes elongated d/t loss of SQ tissues and decrease in elasticity= Normal; be careful when you position pt on left side that war doesn’t fold under head. Hair in canal becomes coarser and longer (especially in men)= Normal; frequent ear irrigation is needed to prevent cerumen clumping. Cerumen is drier and impacts more easily= Teach to irrigate ear canal weekly or whenever pt notices change in hearing Tympanic membrane loses elasticity and may appear dull and retracted= Do not use this finding as the only indication for otitis media. Hearing acuity decreases= Assess hearing with voice test or the watch test. If deficit present refer pt to specialist to determine hearing loss. DO NOT assume all older adults have hearing loss! Ability to hear high-frequency sounds is lost first= Have problems hearing f, s, sh, and pa sounds. Provide quiet environment when speaking and face pt, avoid standing in front of bright lights or windows b/c it interferes with lip reading. Speak slowly, clearly, and in a deeper voice and emphasize beginning word sounds. 5 - Symptoms ▪ Uncomfortable - Itchy watery eyes, sneezing - Allergic rhinosinusitis s/sx are pain over the cheek radiating to the teeth, tenderness to the percussion over the sinuses referred pain to the temple or back of head. - Serum sickness s/sx: fever, arthralgia (achy joints), rash, malaise, lymphadenopathy, polyarthritis and nephritis about 7-12 days after receiving the causative agent. ▪ Life threatening - Allergic asthma, angioedema, anaphylaxis, bronchoconstriction or circulatory collapse - Contact dermatitis ▪ Acute or chronic rash caused by direct contact with either irritant or allergen - Irritant causes a toxic injury to skin - Allergen result in cell-mediated immune reaction in the skin ▪ Localized eczematous eruption with well-defined geometric margins that are consistent w/contact by an irritant or allergen, usually seen in acute form but may be chronic if exposure is repeated, allergy to plants (poison ivy, oxy) classically occurs as linear streaks of vesicles or papules - Cosmetic/perfume allergy head and neck - Hair product allergy: scalp - Shoe/rubber allergy: dorsum of feet - Nickel allergy: earlobes - Mouthwash. Toothpaste allergy: perioral region - Airborne contact allergy (e.g., paint ragweed): generalized - Medications for treatment - Angioedema ▪ Severe type 1 hypersensitivity reaction that involves blood vessels and all layers of skin, mucous membrane, and SQ tissues ▪ Seen in lips, face/tongue, larynx and neck ▪ Intestinal angioedema can occur w/abdominal pain, cramping, nausea, and vomiting ▪ Highest risk is w/in first 24 hours after taking 1st dose ▪ African American have higher incidence of angioedema and laryngeal edema ▪ O2 by nasal cannula is applied 1st ▪ Can give corticosteroids, diphenhydramine, and epinephrine - Hypersensitivity reactions ▪ Patient given PPD and patient previously exposed the PPD can cause sensitized T-Cells to clump at injection site which causes induration and erythema at injection site. Another reaction is poison ivy, skin rashes, local response to insect sting, tissue transplant rejection, and sarcoidosis. Patient can have edema, induration, ischemia, and tissue damage at the site of exposure. ▪ Reaction is self-limiting in 5-7 days and patient treated symptomatically. Monitor reaction site and sites distal to the reaction. Histamine antagonist such as diphenhydramine (Benadryl) are not useful for type IV reactions because 6 histamine is not the main mediator. Corticosteroids can reduce the discomfort and help resolve the reaction more quickly. ➢ Anaphylactic reaction - Treatment - Hypotensive, rapid weak irregular pulse, feeling faint and diaphoretic. - Most life-threatening type 1 hypersensitivity reaction “impending doom” ▪ **EMERGENCY CARE OF PATIENT WITH ANAPHYLAXIS** - Immediately assess respiratory status, airway, and oxygen saturation - Call RRT - Ensure intubation and tracheotomy equipment is ready - Apply O2 using high flow nonrebreather mask at 90-100% - Immediately discontinue the IV drug or infusing solution of a patient having anaphylaxis to that drug DO NOT d/c the IV just change and hang normal saline. - If pt does not have IV start, start one immediately and run NS - Be prepared to start Epinephrine IV (preferred) or IM FIRST LINE o Epi: 1:1000 concentration or 0.3-0.5 mL IV Push or IM o Repeat drug administration as needed every 5-15 minutes until the patient responds - Keep head of bed Elevated about 10 degrees if hypotension is present; if BP is normal elevate HOB to 45 degrees or higher to improve ventilation - Raise the feet and legs - Stay with the patient - Reassure the patient that appropriate interventions are being instituted ▪ Injectable epinephrine - Be prepared to start Epinephrine IV (preferred) or IM FIRST LINE o Epi: 1:1000 concentration or 0.3-0.5 mL IV Push or IM o Repeat drug administration as needed every 5-15 minutes until the patient responds ▪ Second Line: - Antihistamine such as diphenhydramine 25-100mg given IV or IM for angioedema or urticarial. - Use of Epi-pens ▪ Spring loaded injection that delivers 0.3mg of epinephrine per 2 ml dose into SQ tissue ▪ Practice assembly of injection device with a non-drug containing device ▪ Inject the drug into the top of your thigh slightly to the outside holding the device so the needs enter straight down. ▪ Drug is injectable through your pants just avoid seams and pockets where fabric is thicker. ▪ KEEP DEVICE WITH YOU AT ALL TIMES ▪ Use the device when any symptoms of anaphylaxis is present and call 911. ▪ GO TO THE HOSPITAL AFTER USING THE DEVICE WITHIN THE NEXT 4-6 HOURS.. ▪ Protect the device from light and avoid temperature extremes ▪ KEEP SAFETY CAP IN PLACE UNTIL YOU ARE READY TO USE THE DEVICE. ▪ CHECK device for expiration date if too close obtain replacement. Drug clarity if discolored obtain replacement device. If security cap is loose or comes off accidently obtain a replacement device. 7 ➢ Diabetes - Diabetic ketoacidosis ▪ Uncontrolled hyperglycemia- Glucose >300 mg/dL, initial sodum levels may be low or normal, potassium levels depend on how long DKA last before tx once therapy starts serum potassium levels drop quickly ▪ Metabolic acidosis ▪ Increased production of ketones ▪ Most often seen in Type 1 diabetics an occur in Type 2 under severe stress ▪ Results from combination of insulin deficiency and an increase in hormone release that leads to increased liver and kidney glucose production and decreased glucose use in peripheral tissues. - Symptoms: Ketosis= Kussmaul respiration, “rotting fruit” breath, nausea, abdominal pain - Dehydration or electrolyte loss, polyuria, polydipsia, weight loss, dry skin, sunken eyes, soft eyeballs, lethargy, coma - Types of diabetes and causes ▪ Type 1 Diabetes (T1DM) - Caused by beta-cell destruction leading to absolute insulin deficiency - Autoimmune - Idiopathic ▪ Type 2 Diabetes (T2DM) - Ranges from insulin resistance with relative insulin deficiency to secretory deficit with insulin resistance - Different types of insulin: how, when and why used. ▪ Rapid - (Insuline Aspart Injection) Novolog- o Onset- 0.25 hr o Peak-1-3 hr o Duration-3-5 hr - (Human lispro injection) Humalog o Onset- 0.25 hr o Peak 0.5-1.5 hr o Duration: 5 hr - (Insulin glulisine injection) Apidra o Onset- 0.3 hr o Peak: 0.5-1.5 hr o Duration:3-4 hr - (Human lispro injection U-200) Humalog U-200 o Onset: 0.25 hr o Peak: 0.5-1.5 hr o Duration:5 hr - (Insulin human inhalation powder) Afrezza o Onset: 0.25 hr o Peak: 1-1.25 hr o Duration: 2.5 hr