Unit 11; Alterations In Sensory Stimulation

Front 1

The body has a sense that enables a person to be aware of the position and movement of body parts without seeing them, this is called:

Back 1

-Kinesthetic

Front 2

A sense that allows a person to recognize an object's size, shape, and texture:

Back 2

-Stereognosis

Front 3

Name the 3 components of any sensory experience:

Back 3

1.) Reception
2.) Perception
3.) Reaction

Front 4

Describe "normal" sensation and sensory stimulation:

Back 4

-Normally the nervous system continually receives thousands of bits of info from sensory nerve organs, relays the info through appropriate channels, and integrates the info into a meaningful response
-Sensory stimuli reach the sensory organs to elicit an immediate reaction or present info to the brain to be stored for future use
-The nervous system must be intact for the stimuli to reach appropriate brain centers and for the individual to perceive the sensation, the person is then able to react to the stimulus
-When a nerve impulse is created, it travels along pathways to the spinal cord or directly to the brain
-Sensory nerve pathways usually cross over to send stimuli to opposite sides of the brain
-It is impossible to react to all stimuli; the brain prevents sensory bombardment by discarding or storing sensory info

Front 5

This component of sensory experience begins with stimulation of a nerve cell called a receptor, which is usually for only one type of stimulus, such as light, touch, or sound; awareness of unique sensations depends on the receiving region of the cerebral cortex, where specialized brain cells interpret the quality and nature of sensory stimuli; external stimuli (5 senses) and internal stimuli (kinesthetic, stereognosis, and visceral):

Back 5

-Reception

Front 6

A deficit in the normal function of sensory reception and perception:

Back 6

-Sensory Deficit
-a person can lose a sense of self; if a deficit develops gradually or when considerable time has passed since the onset of an acute sensory loss, the person learns to rely on unaffected senses; some senses more become more acute

Front 7

During this component of sensory experience we discard unnecessary stimuli and react to meaningful stimuli; react to what is most significant to us:

Back 7

-Reaction

Front 8

4 aspects must be present for sensory process:

Back 8

1.) Stimulus: agent that stimulates receptor
2.) Receptor: nerve cell
3.) Impulse Conduction: nerve impulse travels to spinal cord or brain
4.) Perception: awareness and interpretation

Front 9

When the person becomes conscious of the stimuli and receives the info, this takes place; includes integration and interpretation of the stimuli based on the person's experiences:

Back 9

-Perception

Front 10

What can influence perception and interpretation of stimuli?

Back 10

-A person's level of consciousness

Front 11

This located in the brain stem mediates all sensory stimuli to the cerebral cortex, so even in deep sleep, clients are able to receive stimuli:

Back 11

-Reticular activating system

Front 12

What 3 parts is the brainstem consist of?

Back 12

1.) Hypothalamus
2.) Thalamus
3.) Subthalamus

Front 13

Sensory stimulation must be of sufficient quality and quantity to maintain a person's awareness; when a person experiences an inadequate quality or quantity of stimulants, such as monotonous or meaningless stimuli, this occurs:

Back 13

-Sensory Deprivation

Front 14

Name 3 types of sensory deprivation that occurs:

Back 14

1.) Reduced sensory input: from visual or hearing loss
2.) Elimination of patterns or restrictive environment: exposure to strange environments)
3.) Restrictive environments: bed rest

Front 15

When a person receives multiple sensory stimuli and cannot perceptually disregard or selectively ignore some stimuli, this occurs; prevents the brain from appropriately responding to or ignoring certain stimuli; the person no longer perceives the environment in a way that makes sense; overload prevents meaningful response by the brain; thought's race, attention scatters, anxiety, and restlessness occurs

Back 15

-Sensory Overload

Front 16

A gradual decline in the ability of the lens to accommodate or to focus on close objects, unable to see near objects clearly; lens becomes larger, firmer, and less elastic:

Back 16

-Presbyopia

Front 17

Cloudy or opaque areas in part of the lens or the entire lens that interfere with passage of light through the lens, causing problems with glare and blurred vision; usually develop gradually, without pain, redness, or tearing in the eye:

Back 17

-Cataract

Front 18

Result when tear glands produce too few tears resulting in itching, burning, or even reduced vision:

Back 18

-Dry Eyes

Front 19

A slowly progressive increase in intraocular pressure that causes progressive pressure against the optic nerve, resulting in peripheral visual loss, decreased visual activity with difficulty adapting to darkness, add halo effect around lights, if left untreated:

Back 19

-Glaucoma

Front 20

Condition in which the macula (specialized portion of the retina responsible for central vision) loses its ability to function efficiently; first signs include blurring of reading matter, distortion or loss of central vision, and distortion of vertical lines:

Back 20

-Macular Degeneration

Front 21

Describe causative factors of sensory deprivation:

Back 21

-Non-stimulating environment
-Inability to process environmental stimuli
-Affective disorders
-Brain damage
-Medications

Front 22

Describe causative factors of sensory overload:

Back 22

-Increased internal stimuli (anxiety)
-Increased external stimuli (loud noises)
-Inability to disregard stimuli (can be medical condition)
-Changes in daily living (anxiety and disorientation)

Front 23

Describe causative factors of sensory deficit:

Back 23

-Presbyopia
-Cataract
-Dry eyes
-Glaucoma
-Macular degeneration
-Presbycusis
-Cerumen accumulation
-Xerostomia
-Peripheral neuropathy
-Stroke

Front 24

Describe factors that affect sensory function:

Back 24

1.) Age: visual changes occurring ages 40-50; hearing changes begin at the age of 30; gustatory and olfactory changes begin around age 50; proprioceptive changes
2.) Meaningful Stimuli: reduces the incidence of sensory deprivation
3.) Amount of Stimuli: excessive amounts causes sensory overload
4.) Social Interaction: lack of causes loneliness, anxiety, and depression
5.) Environmental Factors: noisy surroundings, occupations
6.) Cultural Factors: some ethnicities are more disposed to hearing and vision loss

Front 25

Describe nursing assessment data and nursing interventions for a visual deficit:

Back 25

-Assessment: poor-coordination, squinting, under-reaching or overreaching for objects, persistent repositioning of objects, impaired night vision, accidental falls
-Interventions: tint windows, dim lighting, wear sunglasses outside, telescopic lens eyeglasses, reading books with larger print

Front 26

Describe nursing assessment data and nursing interventions for an auditory deficit:

Back 26

-Assessment: blank looks, decreased attention span, lack of reaction to loud noises, increased volume of speech, positioning of head toward sound, smiling and nodding of head in approval when someone speaks, use of other means of communication such as lipreading or writing, complaints of ringing in ears
-Interventions: work closely with the client; speak up, slowly, facing the pt; amplify telephones and TVs; alarm clocks that shake the bed or signaling devices to allow more freedom; ensure that the problem is not impacted cerumen

Front 27

Describe nursing assessment data and nursing interventions for an olfactory deficit:

Back 27

-Assessment: failure to react to noxious or strong odor, increased body odor, increased sensitivity to odors
-Interventions: improve smell by strengthening pleasant olfactory stimulation; make a client's environment more pleasant with smells such as cologne, mild room deodorizers, fragrant flowers, and sachets; removal of unpleasant odors

Front 28

Describe nursing assessment data and nursing interventions for an gustatory deficit:

Back 28

-Assessment: change in appetite, excessive use of seasoning and sugar, complaints about taste of food, weight change
-Interventions: good oral hygiene keeps the taste buds well hydrated; well seasoned, differently textured food eaten separately heightens taste perception; stimulation of the sense of smell to heighten taste sensation; avoid blending or mixing foods; chew food thoroughly

Front 29

Describe the assessment data and nursing interventions for a tactile deficit:

Back 29

-Assessment: clumsiness, overreaction or underreaction to painful stimulus, failure to respond when touched, avoidance of touch, sensation of pins and needles, numbness; unable to identify object placed in hand
-Interventions: providing touch therapy such as hair brushing and combing, a back rub, and touching of the arms or shoulders are ways of increasing tactile contact

Front 30

Name the 3 layers of the eye:

Back 30

1.) Sclera and transparent cornea (outer)
2.) Choroid (middle)
3.) Retina (inner)

Front 31

The ______ chamber lies between the iris and the posterior surface of the cornea.

Back 31

-anterior

Front 32

The ______ chamber lies between the anterior surface of the lens and the posterior surface of the iris.

Back 32

-posterior

Front 33

A clear watery fluid, fills the anterior and posterior chambers of the anterior cavity of the eye; drains through the trabecular meshwork located in the angle; bathes and nourishes the lens and the endothelium of the cornea:

Back 33

-aqueous humor

Front 34

Is located in the vitreous cavity, the large area behind the lens and in front of the retina:

Back 34

-vitreous humor

Front 35

The ability of the eye to bend light rays so that they fall on the retina:

Back 35

-refraction

Front 36

Nearsightedness or the ability to see near objects clearly, but objects in the distance are blurred; causes light rays to be focused in front of the retina; may occur because of excessive light refraction by the cornea or lens or because of an abnormally long eye:

Back 36

-myopia

Front 37

Farsightedness or the ability to see far objects clearly, but objects close up are blurred; causes light rays to focus behind the retina and requires the pt to use accommodation to focus the light rays on the retina fro near and far objects; occurs when the cornea or lens does not have adequate focusing power or when the eyeball is too short:

Back 37

-hyperopia

Front 38

Caused by an unevenness in the cornea, which results in visual distortion; caused by an irregular corneal curvature; causes the incoming light rays to be bent unequally; light rays do not come to a single point of focus on the retina; can occur in conjuction with any of the other refractive errors:

Back 38

-Astigmatism

Front 39

A form of hyperopia, or farsightedness that occurs as a normal process of aging, usually around age 40:

Back 39

-Presbyopia

Front 40

A tranparent mucous membrane that covers the inner surface of the eyelids (the palpebral conjunctiva) and also extends over the sclera (bulbar conjunctiva), forming a "pocket" under each eyelid:

Back 40

-Conjunctiva

Front 41

Composed of collagen fibers meshed together to form an opaque structure commonly referred to as the "white" of the eye; forms a tough shell that helps protect the intraocular structures:

Back 41

-Sclera

Front 42

Allows light to enter the eye; refracts or bends incoming light rays to help focus them on the retina:

Back 42

-Cornea

Front 43

Provides the color of the eye; its muscles constrict and dilate the pupil:

Back 43

-Iris

Front 44

Allow light to enter the eye; constricts and dilates to control the amount of light that enters the eye:

Back 44

-Pupil

Front 45

A biconvex, avascular, transparent structure located behind the iris; primary function is to bend light rays so that they fall onto the retina; accommodation occurs when the eye focuses on a near object and is facilitated by contraction of the ciliary body, when changes the shape of this:

Back 45

-Lens

Front 46

A highly vascular structure that serves to nourish the ciliary body, the iris, and the outer portion of the retina:

Back 46

-Choroid

Front 47

The innermost layer of the eye that extends and forms the optic nerve; unable to regenerate if destroyed; lines the inside of the eyeball, extending from the area of the optic nerve to the ciliary body; composed of 2 types of photoreceptor cells (rods and cones):

Back 47

-Retina

Front 48

Stimulated in dim or darkened environments

Back 48

-rods

Front 49

Receptive to colors in bright environments:

Back 49

-Cones

Front 50

The center of the retina, a pinpoint depression composed only of densely packed cones and provides the sharpest visual acuity:

Back 50

-Fovea centralis

Front 51

Surrounds the fovea, has a high concentration of cones and is relatively free of blood vessels:

Back 51

-macula

Front 52

This part of the ear is composed of cartilage and connective tissue covered with epithelium, which also lines the external auditory canal:

Back 52

-Auricle

Front 53

This is a slightly S-shaped tube about 1 inch in length in the adult and contains fine hairs and sebaceous (oil) glands and ceruminous (wax) glands:

Back 53

-External Auditory Canal

Front 54

This shiny, translucent, pearl-gray membrane is composed of epithelial cells, connective tissue, and mucous membrane; serves as a partition and an instrument of sound transmission between the external auditory canal and the middle ear:

Back 54

-Tympanic Membrane (Eardrum)

Front 55

This portion of the ear function to conduct and amplify sound waves from the environment; function is to collect and transmit sound waves to the tympanic membrane:

Back 55

-External Ear

Front 56

This portion of the ear to function to conduct and amplify sound waves from the environment; cavity is an air space located in the temporal bone:

Back 56

-Middle Ear

Front 57

This part of the middle ear functions to equalize atmosphere air pressure between the middle ear and the throat and allows the tympanic membrane to move freely:

Back 57

-Eustachian Tube

Front 58

Name the 3 ossicles:

Back 58

1.) malleus
2.) incus
3.) stapes

Front 59

______ of the tympanic membrane cause the ossicles to move and transmit sound waves to the oval window which in return causes the fluid in the inner ear to move and stimulate the receptors of hearing.

Back 59

-Vibrations

Front 60

This portion of the ear functions in hearing and balance; composed of bony labyrinth (maze) surrounding a membrane:

Back 60

-Inner Ear

Front 61

This part of the inner ear is the receptor organ for hearing; it is a coiled structure; contains the organ of Corti, whose tiny hair cells respond to stimulation of selected portions of the basilar membrane according to pitch:

Back 61

-Cochlea

Front 62

Stimulus is converted into an electrochemical impulse and then transmitted to which part of the brain?

Back 62

-Temporal lobe; where it is processed and sound is interpreted

Front 63

What makes up the organ of balance?

Back 63

-Semicircular canals and the vestibule

Front 64

Hearing loss due to aging and can result from aging or insults from a variety of sources:

Back 64

-Presbycusis

Front 65

Ringing in the ears and may accompany the hearing loss that results from the aging process:

Back 65

-Tinnitus

Front 66

An abnormal eye movement that may be observed by others as twitching of the eyeball or described by the patient as a blurring of vision with head or eye movement:

Back 66

-Nystagmus

Front 67

A sense that the person or objects around the person are moving or spinning and is usually stimulated by movement of the head:

Back 67

-Vertigo

Front 68

Discuss assessment findings for a patient experiencing trauma (penetrating, foreign body, or chemical) to the eye:

Back 68

-Pain
-Photophobia
-Redness- diffuse or localized
-Swelling
-Ecchymosis
-Tearing
-Blood in the anterior chamber
-Absent eye movements
-Fluid drainage from eye (blood, CSF, aqueous humor)
-Abnormal or decreased vision
-Visible foreign body
-Prolapsed globe
-Abnormal intraocular pressure
-Visual field defect

Front 69

Discuss interventions for a patient experiencing trauma (penetrating, foreign body, or chemical) to the eye:

Back 69

-Determine mechanism for injury
-Ensure airway, breathing, circulation
-Assess for other injuries
-Assess for chemical exposure
-Begin ocular irrigation immediately in the case of chemical exposure; do not stop until emergency personnel arrive to continue irrigation; sterile, pH-balanced, physiologic solution is best; if unavailable, use any nontoxic liquid
-Assess visual acuity
-Do not put pressure on the eye
-Instruct patient not to blow nose
-Do not attempt to treat the injury
-Stabilize foreign objects
-Cover the eye(s) with dry, sterile patches and a protective shield
-Do not give the patient food or fluids
-Elevate HOB to 45 degrees
-Do not put medication or solutions in the eye unless ordered by physician
-Admin analgesia as appropriate

Front 70

An infection or inflammation of the conjunctiva; may be caused by bacteria, virus, allergens, or chemical irritants; hand washing and using individual or disposable towels helps prevent spreading the condition:

Back 70

-Conjunctivitis

Front 71

This form of conjunctivitis is very common; a.k.a. "pink eye"; epidemics commonly occur in children because of their poor hygiene habits; causative microorganisms: S. aureus, Streptococcus pneumoniae, and Haemophilus influenzae; pt may complain of irritation, tearing, redness, and a mucopurulent drainage; spreads rapidly to the unaffected eye; treatment with antibiotic drops shortens the course of the disorder:

Back 71

-Acute bacterial conjunctivitis

Front 72

This form of conjunctiva is usually mild and self-limiting; complaints of tearing, foreign body sensation, redness, and mild photophobia; treatment is usually palliative including topical corticosteroids providing temporary relief but have no benefit in the final outcome:

Back 72

-Viral Conjunctivitis

Front 73

This form of conjunctivitis can be severe enough to cause significant swelling, sometimes ballooning the conjunctiva beyond the eyelids; defining symptom is itching; burning, redness, and tearing are also symptoms; artificial tears can be effective in diluting the allergen and washing it from the eye, topical meds include antihistamines and corticosteroids are also effective:

Back 73

-Allergic Conjunctivitis

Front 74

An inflammation or infection of the cornea that can be caused by a variety of microorganisms or by other factors; may involve the conjunctiva and/or the cornea (both= keratoconjunctivitis):

Back 74

-Keratitis

Front 75

For this type of keratitis, topical antibiotics are generally effective; risk factors include mechanical or chemical corneal epithelial damage, contact lens wear, debilitation, nutritional deficiencies, immunosuppressed states and contaminated products:

Back 75

-Bacterial Keratitis

Front 76

This type of keratitis includes both herpes simplex virus, herpes zoster ophthalmicus, and epidemic keratoconjuctivitis; HSV is the most frequently occurring infectious cause of corneal blindness in the Western hemisphere; antiviral agents are mostly used:

Back 76

-Viral Keratitis

Front 77

Tissue loss caused by infection of the cornea causes this; can be due to bacteria, viruses, or fungi; often very painful, and pts may feel as if there is a foreign body in their eye; symptoms include: tearing, purulent or watery discharge, redness, and photophobia; treatment is generally aggressive to avoid permanent loss of vision (antibiotic, antiviral, or antifungal eyedrops); can result in corneal scarring and perforation and a corneal transplant may be indicated:

Back 77

-Corneal ulcer

Front 78

Describing nursing interventions for a patient with inflammation and infection of the eye:

Back 78

-Hand washing are essential to prevent spreading organisms
-Apply warm or cool compresses
-Darkening the room
-Provide appropriate analgesics
-Stagger the eyedrops if receiving more than one at a time (q 5 min)
-Advise pt to dispose of all opened or used lens care products and cosmetics

Front 79

Also known as a sty; an infection of the sebaceous glands in the lid margin; most common bacterial infective agent is staphylococcus aureus; a red, swollen, circumscribed, and acutely tender area develops rapidly; apply warm, moist compresses at least 4x/day until it improves:

Back 79

-Hordeolum

Front 80

An opacity within the lens; third leading cause of preventable blindness and the most common cause of self-declared visual disability in the US; caused by blunt or penetrating trauma, congenital factors such as maternal rubella, radiation or UV light exposure, certain drugs such as systemic corticosteroids or long-term topical corticosteroids, and ocular inflammation; complaints of decreased vision, abnormal color perception, and glare:

Back 80

-Cataracts

Front 81

Describe treatment and nursing care for a patient with cataracts:

Back 81

-Surgical removal is the only curative treatment for cataracts
-Changing the pt's eyewear prescription will temporarily relieve some symptoms
-Preop: antibiotic eyedrops, NPO for 6-8 hrs, nurse will instill dilating drops and a nonsteroidal antiinflammatory eyedrop to reduce inflammation and to help maintain pupil dilation
-Postop: usually ready to go home as soon as the effects of sedative agents have worn off; antibiotic drops to prevent infection and corticosteroids drops to decrease the postop inflammatory response; avoid activities that increase that IOP, such as bending or stooping, coughing, or lifting; there will be 4-5 visits in the next 6-8 weeks; when the eye is fully recovered the pt will receive a final prescription for glasses
-No proven measures to prevent the development of cataracts
-Wear sunglasses, avoid extraneous or unnecessary, and maintain appropriate intake of antioxidants vitamins and good nutrition
-Provide safety possible falls or other injuries
-An eye patch may need to be worn and removed usually within 24 hours
-Admin mild analgesics
-If pain is intense, surgeon should be notified because this may indicate hemorrhage, infection, or increased IOP, also notify if there is increased or purulent drainage, increased redness, or any decrease in visual acuity

Front 82

A separation of the sensory retina and the underlying pigment epithelium, with fluid accumulation between the two layers:

Back 82

-Retinal Detachment

Front 83

This cause of retinal detachment is an interruption in the full thickness of the retinal tissue, and they can be classified as tears or holes; most common cause:

Back 83

-Retinal breaks

Front 84

This cause of retinal detachment is atrophic retinal breaks that occur spontaneously:

Back 84

-Retinal holes

Front 85

This cause of retinal detachment can occur as the vitreous humor shrinks during aging and pulls on the retina:

Back 85

-Retinal tears

Front 86

Once there is a break in the retina, liquid vitreous can enter the subretinal space between the sensory layer and the retinal pigment epithelium layer, causing a _________ retinal detachment.

Back 86

-Rhegmatogenous

Front 87

Retinal detachment can occur when abnormal membranes mechanically pull on the retina, this called:

Back 87

-Tractional detachment

Front 88

This retinal detachment occurs with conditions that allow fluid to accumulate in the subretinal space:

Back 88

-Secondary or exudative detachment

Front 89

Describe signs and symptoms for retinal detachment:

Back 89

-Photopsia (light flashes)
-Floaters
-"cobweb," "hairnet," or ring in the vision flield
-Painless loss of peripheral or central vision
-Area of visual loss corresponds to the area of detachment

Front 90

This method of retinal detachment treatment involves using an intense, precisely focused light beam, such as the argon laser, to create an inflammatory reaction; it produces a scar that seals the edges of the hole or tear, and prevents fluid from collecting in the subretinal space and causing a detachment:

Back 90

-Laser photocoagulation

Front 91

This method of retinal detachment treatment involves using extreme cold to create the inflammatory reaction that produces the sealing scar:

Back 91

-Cryopexy

Front 92

This method of retinal detachment treatment is an extraocular surgical procedure that involves indenting the globe so that the pigment epithelium, choroid, and sclera move toward the detachment:

Back 92

-Scleral buckling

Front 93

This method of retinal detachment treatment is the intravitreal injection of a gas to form a temporary bubble in the vitreous that closes retinal breaks and provides apposition of the separated retinal layers:

Back 93

-Pneumatic retinopexy

Front 94

This method of retinal detachment treatment is the actual surgical removal of the vitreous; may be used to relieve traction on the retina, especially when the traction result from proliferative diabetic retinopathy:

Back 94

-Vitrectomy

Front 95

Describe nursing interventions for a patient experiencing retinal detachment:

Back 95

-Reattachment is successful in 90% of retinal detachment
-Bed rest, antibiotics, antiinflammatory, or dilating agents admin
-Promote use of protect eyewear for prevention

Front 96

The most common cause of irreversible central vision loss in persons over age 60; there are 2 forms: wet and dry:

Back 96

-Age-related macular degeneration (AMD)

Front 97

This form of age-related macular degeneration is the more common form (90% of all cases), may often notice close vision tasks becoming more difficult; macular cells start to atrophy, leading to a slowly progressive and painless vision loss:

Back 97

-Dry AMD

Front 98

This form of age-related macular degeneration is the more severe form; accounts for 90% of the cases of AMD-related blindness; more rapid onset and is noted by the development of abnormal blood vessels in or near the macula:

Back 98

-Wet AMD

Front 99

Describe risk factors for the development of AMD:

Back 99

-Genetic factors
-Long-term exposure to UV light
-Hyperopia
-Cigarette smoking
-Light colored eyes
-Nutrition may help to decrease the progression of AMD (vit C, vit E, beta-carotene, and zinc)

Front 100

This form of AMD starts with the accumulation of yellowish colored extracellular deposits called drusen in the retinal pigment epithelium resulting in atrophy and degeneration of the macular cells:

Back 100

-Dry AMD

Front 101

This form of AMD is characterized by the growth of new blood vessels from their normal location in the choroids to an abnormal location in the retinal epithelium; as the new blood vessels leak, scar tissue gradually forms; acute vision loss may occur:

Back 101

-Wet AMD

Front 102

Describe signs and symptoms of age-related macular degeneration:

Back 102

-Blurred and darkened vision
-Scotomas (blind spots in the visual field)
-Metamorphopsia (distortion of vision)
-Many people may not notice unilateral early changes in their vision if the other eye is not affected

Front 103

-Blind spots in the visual field

Back 103

-Scotomas

Front 104

-Distortion of vision

Back 104

-Metamorphopsia

Front 105

Describe nursing interventions for a patient with AMD:

Back 105

-Active listening and facilitating
-Include members in discussions and encourage members to express their concerns
-Always communicate in a normal conversational tone and manner with the patient, and the nurse should address the patient, not a family member or friend that may be with the patient
-Common courtesy: saying good-bye on leaving
-Making eye contact
-Orientation to the environment
-Sighted-guide technique

Front 106

This is not one disease but rather a group of disorders characterized by:
1.) increased IOP and the consequences of elevated pressure
2.) optic nerve atrophy
3.) peripheral visual field loss
-directly related to the balance or imbalance of the formation and reabsorption of aqueous humor; second leading cause of permanent blindness in the US and the leading cause of blindness among African Americans

Back 106

-Glaucoma

Front 107

This occurs when the rate of inflow is greater than the rate of outflow, IOP can rise above the normal limits:

Back 107

-Etiology of Glaucoma

Front 108

This form of glaucoma represents 90% of the cases; outflow of aqueous humor is decreased in the trabecular meshwork; drainage become clogged:

Back 108

-Primary open-angled glaucoma (POAG)

Front 109

This form of glaucoma represents 10% of the total number of glaucoma cases in the US; mechanism reducing the outflow of aqueous is angle closure; caused from the lens bulging forward as a result of an age-related process:

Back 109

-Primary angle-closure glaucoma (PACG)

Front 110

This form of glaucoma increased IOP results from other ocular or systemic conditions that may block the outflow channels in some way; may be associated with inflammatory processes that block the outflow channels such as trauma and ocular neoplasms:

Back 110

-Secondary glaucoma

Front 111

Describe signs and symptoms of POAG:

Back 111

-develops slowly and without symptoms
-usually does not notice the gradual visual field loss until peripheral vision has been severely compromised

Front 112

Describe signs and symptoms of PACG:

Back 112

-sudden, excruciating pain in or around the eye
-N & V
-colored halos around lights, blurred vision, and ocular redness

Front 113

What is the normal IOP value?

Back 113

-10 to 21 mmHg

Front 114

What is the expected value for someone with POAG?

Back 114

-Between 22 and 32 mmHg

Front 115

What is the expected value for someone with PACG?

Back 115

-May be 50 mmHg or higher

Front 116

Describe treatment for a patient experiencing glaucoma:

Back 116

-POAG: drug therapy which controls but does not cure the disease; argon laser trabeculoplasty; filtering procedure; an implant designed as a small tube and reservoir to shunt fluid
-PACG: an ocular emergency that requires immediate interventions; miotics and oral or IV hyperosmotic agents
-Secondary: resolves primary cause

Front 117

Describe nursing interventions for a patient experiencing glaucoma:

Back 117

-Nurse should check drug records and documentation before administering meds to the pt with PACG and should instruct the pt not to take any mydriatic-producing meds
-acute angle-closure: admin meds appropriately and in a timely manner; dimming lighting; applying cool compresses to the pt's forehead, and providing a quiet and private space for the pt
-Stress the importance of follow-up care; provide info regarding the disease and the meds

Front 118

The action for this drug category is both a noncardioselective and cardioselective blocker; probably decreases aqueous humor production; management of chronic open-angled glaucoma and other forms of ocular HTN

Back 118

-Beta-adrenergic blockers

Front 119

Describe side effects, nursing considerations, and route for beta-adrenergic blockers:

Back 119

-Side effects: transient discomfort, systemic reactions rarely reported but include bradycardia, heart block, pulmonary distress, headache, depression; (b2) transient ocular discomfort, blurred vision, photophobia, blepharoconjunctivitis, bradycardia, decreased BP, bronchospasm, headache, depression
-Nursing Considerations: contraindicated in pt with bradycardia, cardiogenic shock, or overt cardiac failure; systemic absorption can have additive effect with systemic b1-blocking agents; (b2) also contraindicated in pts with asthma or severe COPD; be sure to cover tear ducts when instilling meds to avoid a systemic reaction (hold for 1-2 min); wait 5 minutes before instilling another drop
-Route: Eye drops

Front 120

The action and use of this category of drug is converted to epinephrine inside the eye; decreases aqueous humor production; enhances outflow facility; management of glaucoma (lowers IOP by decreasing aqueous humor production); used to control or prevent acute postlaser IOP rise:

Back 120

-alpha-adrenergic agonist

Front 121

Describe side effects, nursing considerations, and route for alpha-adrenergic blockers:

Back 121

-Side effects: ocular discomfort and local irritation, redness, tachycardia, HTN, arrhythmias
-Nursing Considerations: wait 15 minutes before inserting contacts, contraindicated in pt with narrow-angle glaucoma; teaching punctual occlusion to pt at risk of systemic reactions; not to exceed 1 drop; wait 5 minutes between drops (of another meds)
-Route: eye drop

Front 122

The action and use of this category of drug is parasympathetic, stimulates iris sphincter contraction causing miosis and opening of trabecular meshwork, facilitating aqueous outflow, also partially inhibits cholinesterase; treatment of open-angle glaucoma (facilitates the outflow of aqueous humor); also used to facilitate miosis after ophthalmic surgery and counteracts mydriatics:

Back 122

-cholinergic agents (miotics)

Front 123

Describe side effects, nursing considerations, and route for cholinergic agents (miotics):

Back 123

-Side effects: transient ocular discomfort, headache, browache, blurred vision, decreased dark adaptation, syncope, salivation, dysrhythmias, vomiting, diarrhea, hypotension, retinal detachment (rare)
-Nursing Considerations: caution pt about decreased visual acuity caused by miosis, particularly dim light; cover tear duct and hold for 1-2 minutes while instilling meds to avoid systemic effects; wait 5 minutes before instilling another drop
-Route: eye drops

Front 124

The use and action for this category of drug is for the management of open-angle glaucoma or other forms of ocular HTN; decreases aqueous humor production:

Back 124

-Carbonic Anhydrase Inhibitors

Front 125

Describe side effects, nursing considerations, and route for carbonic anhydrase inhibitors:

Back 125

-Side effects: (systemic) paresthesias, especially "tingling" in the extremities; hearing dysfunction or tinnitus; loss of appetite; taste alteration; GI disturbances; drowsiness; confusion (topical) transient stinging, blurred vision, redness
-Nursing Considerations: be aware of sulf allergies (anaphylaxis may occur) diuretic effect can lower electrolyte levels; ask pt about aspirin use; drug should not be given to pt on high-dose aspirin therapy; may exacerbate kidney stones; should not be used in pts with CCr<30 ml/min

Front 126

This auditory problem involves inflammation or infection of the epithelium of the auricle and ear canal; caused by infection, dermatitis, or both (bacteria or fungus); Pseudomonas aeruginosa is the most common bacteria; fungi are often the causative agents, especially in warm, moist climates:

Back 126

-External Otitis

Front 127

Describe the signs and symptoms of external otitis:

Back 127

-Pain noted on movement of the auricle or on application of pressure to the tragus
-Drainage from the ear may be serosanguineous or purulent
-Temperature elevation
-Swelling of the ear canal can block hearing and cause dizziness

Front 128

Describe nursing actions and treatment for a patient experiencing external otitis:

Back 128

-Diagnosis is made by observation with the otoscope light using the largest speculum that the ear will accommodate without causing the pt unnecessary discomfort
-C & S and mild analgesics, antibiotic drops. corticosteroids (not for fungal infection)
-Warm, moist compresses or heat may be applied
-Improvement should occur in 48 hrs, but 7 to 14 days are required for complete resolution
-The drops should be admin at room temp because cold drops can cause dizziness in the pt, due to stimulation of the semicircular canals
-Tip of the dropper should not touch the ear to prevent contamination of the entire bottle of drops
-Pt should lay on side to admin drops and maintain position for 2 min after to allow dispersion of drops

Front 129

This auditory problem is the most common problem of the middle ear usually a childhood disease associated with colds, allergies, sore throats, and blockage of the eustachian tube; earlier the first episode, the greater the risk of subsequent episodes occurring:

Back 129

-Acute otitis media

Front 130

Describe signs and symptoms of acute otitis media:

Back 130

-Pain, fever, malaise, headache, and reduced hearing

Front 131

This treatment for acute otitis media involves an incision in the tympanum to release the increased pressure and exudate from the middle ear and placing a tympanostomy tube:

Back 131

-Myringotomy

Front 132

Untreated or repeated attacks of acute otitis media may lead to this; common in persons who experience episodes of acute otitis media in early childhood; S. aureus, Proteus mirabilis, and P. aeruginosa organisms; both the middle ear and the air cells of the mastoid can be involved:

Back 132

-Chronic otitis media

Front 133

Describe signs and symptoms of chronic otitis media:

Back 133

-A purulent exudate and inflammation that can involve the ossicles, eustachian tube, and mastoid bone
-Often painless
-Nausea and episodes of dizziness can occur
-Hearing loss as a result of destruction of the ossicles, a tympanic membrane perforation, or the accumulation of fluid in the middle ear space
-Facial palsy or an attack of vertigo

Front 134

This complication of chronic otitis media is a mass of epithelial cells and cholesterol in the middle ear; may destroy the adjacent bones, including the ossicles and can cause extensive damage to the structures of the middle ear, can erode the bony protection of the facial nerve, may create a labyrinthine fistula, or can even invade the dura, threatening the brain:

Back 134

-Cholesteatoma

Front 135

This form a surgical therapy for chronic otitis media involves reconstruction of the tympanic membrane and/or the ossicular chain:

Back 135

-Tympanoplasty

Front 136

This form of surgical therapy for chronic otitis media is often performed with a tympanoplasty to remove diseased tissue and the source of infection; removal of tissue stops at the middle ear structures that appear capable of functioning in the conduction of sound:

Back 136

-Mastoidectomy

Front 137

This form of surgical therapy for chronic otitis media is surgical reconstruction limited to repair of a tympanic membrane perforation:

Back 137

-Myringoplasty

Front 138

This auditory problem is an inflammation of the middle ear in which a collection of fluid is present in the middle ear space; fluid may be thin, mucoid, or purulent; commonly follows URI and/or sinus infections, barotrauma (caused by pressure changes), or otitis media; complaints of feeling a fullness of the ear, "plugged" feeling or popping, and decreased hearing:

Back 138

-Otitis media with effusion

Front 139

Endolymphatic hydrops; is characterized by symptoms caused by inner ear disease, including episodic vertigo, tinnitus, fluctuating sensorineural hearing loss, and aural fullness; severe attacks of vertigo with nausea and vomiting beginning between 30-60 years of age; cause is unknown, but it results in an excessive accumulation of endolymph in the membranous labyrinth; membranous labyrinth ruptures, mixing with high-K endolymph with low-K perilymph; sense of ear fullness, tinnitus, and a decrease in hearing acuity; attacks may be hours or days, and attack may occur several times a year; pallor sweating, nausea, vomiting; hearing loss fluctuates, and with continued attacks, hearing recovery is often less complete with each episode, eventually leading to progressive permanent hearing loss:

Back 139

-Meniere's Disease

Front 140

Describe nursing interventions for a patient experiencing Meniere's disease:

Back 140

-During acute attack: antihistamines, anticholinergics, and benzodiazepines to decrease the abnormal sensation and lessen symptoms such as nausea and vomiting; bed rest, sedation, antiemetics or antivertigo drugs for motion sickness admin orally, parenterally, or IV
-Management between attacks may include diuretics, antihistamines, and a low-Na diet
-Nursing: provide pt safety, quiet darkened room in a comfortable position; avoid sudden head movements or position changes; fluorescent or flickering lights or watching TV may exacerbate symptoms and should be avoided; provide emesis basin; keep side rails up and the bed low in position; call for assistance when getting out of bed; meds and fluids are admin parenterally, and I & O are monitored; assist with ambulation

Front 141

This hearing loss occurs in the outer and middle ear and impairs the sound being conducted from the outer to the inner ear; caused by conditions interfering with air conduction, such as impacted cerumen and foreign bodies, middle ear disease, otosclerosis, and stenosis of the external auditory canal; most common cause is otitis media with effusion:

Back 141

-Conductive Hearing Loss

Front 142

When does an air-bone gap occur?

Back 142

-When hearing sensitivity by bone conduction is better than by air conduction (during conductive hearing loss)

Front 143

This hearing loss is caused by impairment of function of the inner ear or the vestibulocochlear nerve; caused by congenital and hereditary factors, noise trauma, aging (presbycusis), Meniere's dz, ototoxicity, systemic dz, immune dz, trauma; ability to hear sound but not understand speech, and the lack of understanding of the problem by others:

Back 143

-Sensorineural Hearing Loss

Front 144

What is the range for normal hearing?

Back 144

-0-15 dB

Front 145

What is the range for slight hearing loss?

Back 145

-16-25 dB

Front 146

What is the range for mild hearing impairment?

Back 146

-26-40 dB

Front 147

What is the range for moderate hearing impairment?

Back 147

-41-55 dB

Front 148

What is the range for moderately severe hearing impairment?

Back 148

-56-70 dB

Front 149

What is the range for severely impaired hearing loss?

Back 149

-71-90 dB

Front 150

What is the range for profoundly deaf?

Back 150

-greater than 91 dB

Front 151

Describe signs and symptoms of a patient experiencing hearing loss:

Back 151

-Asking others to speak up, answering questions inappropriately, not responding when not looking at the speaker, straining to hear, cupping hand around ear, showing irritability with others who do not speak up, and increasing sensitivity to slight increases in noise level
-Family and friends are often first to notice hearing loss
-Irritability, withdrawal, suspicion, loss of self-esteem, and insecurity

Front 152

Describe nursing interventions for a patient experiencing hearing loss:

Back 152

-Health teaching regarding avoidance of continued exposure to noise levels greater than 85 to 95 dB is essential
-Drugs commonly associated with ototoxicity include salicylates, diuretics, antineoplastic drugs, and antibiotics
-Symptoms of ototoxicity are tinnitus, sensorineural hearing loss, and vestibular dysfunction
-Hearing aids: gradually introduce to noise; initially use of the hearing aid should be restricted to quiet situations in the home (must first adjust to voices and household sounds), next a small party, then outdoors, then grocery stores and shopping malls
-Hearing aid protection: placed in a dry, cool area; battery should be disconnected or removed when not in use; battery lasts 1 week and should buy 1 month worth; ear molds should be cleaned weekly or as needed

Front 153

Hearing loss associated with aging, includes the loss of peripheral auditory sensitivity, a decline in word recognition ability and associated psychologic and communication issues:

Back 153

-Presbycusis

Front 154

Nosebleed; occurs in a bimodal distribution, with children less than 10 years of age and adults over the age of 50 most affected; causes by trauma, foreign bodies, topical corticosteroid use, nasal spray abuse, street drug use, anatomic malformation. allergic rhinitis, or tumors; any condition that prolongs bleeding time or alters platelet counts will predispose:

Back 154

-Epistaxis

Front 155

Describe nursing actions for a patient experiencing epistaxis:

Back 155

1.) Keep the patient quiet
2.) Place the patient in a sitting position, leaning forward, or if not possible, in a high Fowler's position
3.) Apply direct pressure by pinching the entire soft lower portion of the nose for 10-15 min
4.) Apply ice compresses to the nose
5.) Partially insert a small gauze pad into the bleeding nostril, and apply digital pressure if bleeding continues
6.) Obtain medical assistance if bleeding does not stop
-If first aid is not effective, application of a vasoconstrictive gent, cauterization, or anterior packing by a health care provider
-Nasal packing: may alter respiratory status; closely monitor respiratory rate, HR and rhythm, SpO2, LOC, observe for signs of aspiration; very painful, admin mild opioids and antibiotics
-Nasal packing removal: left in for 3 days, admin opioids prior to surgery

Front 156

Also known as the common cold or acute coryza; is caused by an adenovirus that invades the upper respiratory tract and often accompanies an acute URI; virus can survive for up to 3 days:

Back 156

-Acute rhinitis

Front 157

Describe signs and symptoms of acute rhinitis:

Back 157

-Tickling, irritation, sneezing, or dryness of the nose or nasopharynx, copious nasal secretions, some nasal obstruction, watery eyes, elevated temp, general malaise, and headache

Front 158

Describe nursing actions for a patient experiencing acute rhinitis:

Back 158

-Rest, fluids, proper diet, antipyretics, and analgesics
-Complications include: pharyngitis, sinusitis, otitis media, tonsillitis, and lung infections
-Antibiotic therapy is not indicated
-Advise to avoid crowded, close situations and other persons who have obvious cold symptoms; frequent hand washing and avoiding hand-to-face contact
-Drink increased amounts of fluids to liquefy secretions
-Antihistamine or decongestion therapy help reduce symptoms
-Anti

Front 159

Develops when the ostia (exit) from the sinuses are narrowed or blocked by inflammation or hypertrophy (swelling) of the mucosa; secretions that accumulate behind the obstruction provide a rich medium for growth of bacteria, viruses, and fungi, all of which may cause infection:

Back 159

-Sinusitis

Front 160

This type of sinusitis is most commonly caused by Streptococcus pneumoniae, Haemophilus influenzae, or Moraxella catarrhalis:

Back 160

-bacterial sinusitis

Front 161

This type of sinusitis follows an upper respiratory infection in which the virus penetrates the mucous membrane and decreases ciliary transport:

Back 161

-viral sinusitis

Front 162

This type of sinusitis is uncommon and is usually found in patients who are debilitated or immunocompromised:

Back 162

-fungal sinusitis

Front 163

This form of sinusitis usually results from an URI, allergic rhinitis, swimming, or dental manipulation, all of which can cause inflammatory changes and retention of secretions; typically worsen after 5-7 days:

Back 163

-Acute Sinusitis

Front 164

This form of sinusitis lasts longer than 3 weeks; a persistent infection usually associated with allergies and nasal polyps; generally results from repeated episodes of acute sinusitis that result in irreversible loss of the normal ciliated epithelium lining the sinus cavity:

Back 164

-Chronic Sinusitis

Front 165

Describe signs and symptoms of sinusitis:

Back 165

-Causes significant pain over the affected sinus, purulent nasal drainage, nasal obstruction, congestion, fever, and malaise
-Hyperemic and edematous mucosa, a discolored purulent nasal drainage, enlarged turbinates, and tenderness over the involved frontal and/or maxillary sinusitis
-Recurrent headaches
-Patients with asthma have sinusitis

Front 166

Describe nursing interventions for a patient experiencing sinusitis:

Back 166

-Antibiotics to treat the infection if the persists longer than 7 days without treatment; usually amoxicillin for 10-14 days
-If symptoms do not resolve, the antibiotic should be changed to a broader spectrum agent
-Medications can also relieve symptoms: oral or topical decongestants to promote drainage, nasal corticosteroids to decrease inflammation, and antihistamines (1st generations should be avoided)
-Recommend taking a hot shower and irrigating the nose

Front 167

Describe nursing actions for a patient following ear surgery:

Back 167

-Patient will be positioned flat and side-lying with the operative side up
-It is normal to have impaired hearing during the postop period if there is packing in the ear
-Change dressing and cotton packing daily
-It is necessary to monitor the tightness of the dressing to prevent tissue necrosis and the amount and type of drainage postop

Front 168

A locally invasive malignancy arising from epidermal basal cells; most common type of skin cancer and also the least deadly; usually occurs in middle-aged to older adults; almost never spreads beyond the skin; cure rate of greater than 90% when used correctly on primary lesions:

Back 168

-basal cell carcinoma

Front 169

Change in basal cells; no maturation or normal keratinization; continuing division of basal cells and formation of enlarging mass; related to excessive sun exposure, genetic skin type, x-ray radiation, scars, and some types of nevi; basal cells possibly pigmented:

Back 169

-Etiology and Pathophysiology of Basal Cell Carcinoma

Front 170

Describe signs and symptoms of basal cell carcinoma:

Back 170

-Nodular and Ulcerative: small, slowly enlarging papule; borders semitranslucent or "pearly" with overlying telangiectasia; erosion, ulceration, and depression of center; normal skin markings lost
-Superficial: erythematous, sharply defines, barely elevated multinodular plaques with varying scaling and crusting; similar to eczema but not pruritic

Front 171

Neoplastic growth of melanocytes anywhere on skin, eyes, or mucous membranes; classification according to major histologic mode of spread; potential invasion and widespread metastases:

Back 171

-Etiology and Pathophysiology of Malignant Melanoma

Front 172

Describe signs and symptoms of malignant melanoma:

Back 172

-Irregular color, surface, and border; variegation of color including red, white, blue, black, gray, brown; flat or elevated; eroded or ulcerated; often under 1 cm in size; most common sites in males are back, then chest; in females are legs, then back

Front 173

A tumor arising in melanocytes, which are the cells producing melanin; has the ability to metastasize to any organ, including the brain and heart; most deadly skin caner, and its incidence is increasing faster than any other cancer; exact cause is unknown; risk factors include: chronic UV exposure without protection or overexposure to artificial light; fair skin and eyes; genetic factors, mutated gene, immunosuppression, dysplastic nevi, and exposure to environmental hazards:

Back 173

-Malignant Melanoma

Front 174

This type of melanoma is the most common type, is the most curable, and often occurs on chronically sun-exposed area such as the legs and upper back; frequently arises from a preexisting mole:

Back 174

-Superficial spreading melanoma (SSM)

Front 175

This type of melanoma is commonly located on the face and is often found in elderly patients; appear as flat, brown, irregular patches:

Back 175

-Lentigo malignant melanoma (LMM)

Front 176

This type of melanoma appears on the soles, palms, mucous membranes, and terminal phalanges; more common in Asian people and those with dark skin; is the most frequently misdiagnosed melanoma because it may resemble a benign lesion such as a blood blister or polyp, or even a basal cell carcinoma:

Back 176

-Acral-lentiginous melanoma (ALM)

Front 177

Occurs more often in men and can be located anywhere on the body; more aggressive type of melanoma that develops and invades rapidly:

Back 177

-Nodular melanoma

Front 178

Describe treatment for a patient with malignant melanoma:

Back 178

-the most important prognostic factor is tumor thickness at the time of diagnosis
-Breslow measurement: indicates tumor depth in millimeters
-Clark level: indicates the number of skin layers involved (1-5; the higher the number, the deeper the melanoma)
-chemo, biologic therapy, surgery, and/or radiation therapy

Front 179

In this stage, melanoma is confined to one place (in situ) in the epidermis; is nearly 100% curable by excision:

Back 179

-Stage I

Front 180

In this stage, melanoma 5-survival rate (75-95%) and can vary depending on the sentinel node biopsy results, which indicate if metastasis has occurred:

Back 180

-Stage II

Front 181

In this stage, melanoma has metastasized to regional lymph nodes and the pt has a 45% change of 5-year survival:

Back 181

-Stage III

Front 182

In this stage of melanoma, metastasis to other organs occurs, treatment than become mostly palliative:

Back 182

-Stage IV

Front 183

Caused by Candida albicans; also known as moniliasis; 50% of adults symptom-free carriers; presenting in warm, moist areas such as groin area, oral mucosa, and submammary folds; HIV infection, chemo, radiation, and organ transplantation related to depression of cell-mediated immunity that allows yeast to become pathogenic:

Back 183

-Etiology and Pathophysiology of Candidiasis

Front 184

Describe signs and symptoms of candidiasis:

Back 184

-Mouth: white, cheesy plaque, resembles milk curds
-Vagina: with red, edematous, painful vaginal wall, white patches, vaginal discharge; pruritus; pain on urination and intercourse
-Skin: diffuse papular erythematous rash with pinpoint satellite lesions around edges of affected area

Front 185

Describe treatment for a patient experiencing candidiasis:

Back 185

-Microscopic examination and culture; nystatin or other specific med as vaginal suppository or oral lozenge; abstinence or use of a condom; eradication of infection with appropriate med; skin hygiene to keep it clean and dry; mycostatin powder effective on skin lesions

Front 186

Various dermatophytes, commonly referred to as ringworm:

Back 186

-Tinea Corporis

Front 187

Various dermatophytes; commonly referred to as jock itch:

Back 187

-Tinea Cruris

Front 188

-Various dermatophytes; commonly referred to as athlete's foot:

Back 188

-Tinea Pedis

Front 189

Various dermatophytes; incidence increases with age:

Back 189

-Tinea Unguium

Front 190

Describe s&s and treatment for tinea corporis (ringworm):

Back 190

-S&S: typical annular (ring-like) scaly appearance, well-defined margins; erythematous
-Treatment: cool compresses, topical antifungals for isolated patches; creams or solutions of miconazole (Monistat), clotrimazole (Lotrimin), and butenafine (Mentax)

Front 191

Describe s&s and treatment for tinea cruris (jock itch):

Back 191

-S&S: well-defined scaly plaque in gorin area; does not affect mucous membranes
-Treatment: topical antifungal cream or solution

Front 192

Describe s&s and treatment for tinea pedis (athlete's foot):

Back 192

-S&S: interdigital scaling and maceration; scaly plantar surface sometimes with erythema and blistering; may be pruritic; possibly painful
-Treatment: topical antifungal cream, gel, solution, spray or powder

Front 193

Describe s&s and treatment for tinea unguium (onychomycosis):

Back 193

-S&S: only few nails on one hand may be affected; toenails more commonly affected; scaliness under distal nail plate; brittle, thickened, broken/crumbling nails with yellowish discoloration
-Treatment: topical antifungal cream or solution if unable to tolerate systemic treatment; oral antifungal; thinning of toenails if needed; nail avulsion

Front 194

Activation of the varicella-zoster virus; frequent occurrence in immunosuppressed patients; potentially contagious to anyone who has not had varicella or who is immunosuppressed:

Back 194

-Herpes Zoster (Shingles)

Front 195

Describe s&s and treatment for a patient with Shingles:

Back 195

-S&S: linear distribution along a dermatome of grouped vesicles on erythematous base; usually unilateral on trunk, face, and lumbosacral areas; burning, pain, and neuralgia preceding outbreak; mild to severe pain during outbreak
-Treatment: antiviral agents, wet compresses, ointment to lesions, analgesia; gabapentin indicated in the treatment of postherpetic neuralgia; usual healing without complications but scarring and postherpetic neuralgia

Front 196

Inflammation of SQ tissues; possibly secondary complication or primary infection; often following break in skin; S. aureus and streptococci usual agents; deep inflammation of SQ tissue from enzymes produced by bacteria:

Back 196

-Cellulitis

Front 197

Describe s&s and treatment for a patient experiencing cellulitis:

Back 197

-S&S: hot, tender, erythematous, and edematous area with diffuse borders; chills, malaise and fever
-Treatment: moist heat, immobilization and elevation, systemic antibiotic therapy, hospitalization if severe; progression to gangrene possible if untreated

Front 198

Chronic dermatitis that involves excessively rapid turnover of epidermal cells; family predisposition:

Back 198

-Psoriasis

Front 199

Describe s&s of psoriasis:

Back 199

-Sharply demarcated silvery scaling plaques commonly on the scalp, elbows, knees; palms, soles, and fingernails possibly affected; localized or general, intermittent or continuous

Front 200

Describe treatment for a patient experiencing psoriasis:

Back 200

-Goal is to reduce inflammation and suppress rapid turnover of epidermal cells; topical treatment may be time consuming; usually topical corticosteroids, tar, anthralin; sunlight; UV light; immunosuppressants

Front 201

Circumscribed, flat area with a change in skin color; less than 1 cm in diameter (freckles, petechiae, measles, flat mole [nevus]):

Back 201

-Macule

Front 202

Elevated, solid lesion; less than 1 cm in diameter (wart, elevated moles):

Back 202

-Papule

Front 203

Circumscribed, superficial collection of serous fluid; less than 1 cm in diameter (varicella, herpes zoster, second-degree burn)

Back 203

-Vesicle

Front 204

Cricumscribed, elevated superficial, solid lesion; greater than 1 cm in diameter (psoriasis, seborrheic and active keratoses):

Back 204

-Plaque

Front 205

Firm, edematous, irregularly shaped area; diameter variable (insect bite, urticaria):

Back 205

-Wheal

Front 206

Elevated, superficial lesion filled with purulent fluid (acne, impetigo):

Back 206

-Pustule

Front 207

Linear crack or break from the epidermis to dermis; dry or moist (athlete's foot, cracks at corner of the mouth):

Back 207

-Fissure

Front 208

Excess, dead epidermal cells produced by abnormal keratinization and shedding (flaking of skin after a drug reaction or scarlet fever):

Back 208

-Scale

Front 209

Loss of the epidermis and dermis; crater-like; irregular shape (pressure ulcer, chancre):

Back 209

-Ulcer

Front 210

Depression in skin resulting from thinning of the epidermis or dermis (aged skin, striae):

Back 210

-Atrophy

Front 211

Area in which epidermis is missing, exposing the dermis (scabies, abrasion, or scratch):

Back 211

-Excoriation

Front 212

-Annular:

-Nummular, discoid

Back 212

-Ring shaped

-Coinlike

Front 213

-Gyrate:

-Polymorphous:

Back 213

-Spiral shaped

-Occurring in several forms

Front 214

-Iris lesions

-Punctate:

Back 214

-Concentric rings or "bull's eyes"

-Marked by points or dots

Front 215

-Linear:

-Serpiginous:

Back 215

-In a line

-Snakelike

Front 216

-Confluent:

-Diffuse:

Back 216

-Merging together

-Wide distribution

Front 217

-Discrete:

-Generalized:

Back 217

-Separate from other lesions

-Diffuse distribution

Front 218

-Grouped:

-Localized:

Back 218

-Cluster of lesions

-Limited areas of involvement that are clearly defined

Front 219

-Satellite:

-Solitary:

Back 219

-Single lesion in close proximity to a lg grouping

-A single lesion

Front 220

-Symmetric:

-Zosteriform:

Back 220

-Bilateral distribution

-Bandlike distribution along a dermatome area

Front 221

Tumor consisting of blood or lymph vessels:

Back 221

-Angioma

Front 222

Yellow discoloration of skin, no yellowing of sclerae, most noticeable on palms and soles:

Back 222

-Carotenemia

Front 223

-Light Skin: grayish-blue tone, especially in nail beds, earlobes, lips, mucous membranes, and palms and soles of feet
-Dark Skin: ashen or gray color most easily seen in the conjunctiva of the eye, mucous membranes, and nail beds:

Back 223

-Cyanosis

Front 224

-Light Skin: Dark red, purple, yellow, or green color, depending on age of bruise
-Dark Skin: Purple to brownish-black; difficult to see unless occurring in an area of light pigmentation:

Back 224

-Ecchymosis

Front 225

-Light Skin: reddish tone, possibly accompanied by increased skin temp secondary to localized inflammation
-Dark Skin: Deeper brown or purple skin tone with evidence of increased skin temp secondary to inflammation:

Back 225

-Erythema

Front 226

-Light Skin: Yellowish color of skin, sclera, fingernails, palms, and oral mucosa
-Dark Skin: Yellowish-green color most obviously seen in sclera of eye

Back 226

-Jaundice

Front 227

-Light Skin: Pale skin color that may appear white or ashen, also evident on lips, nail beds, and mucous membranes
-Dark Skin: Underlying red tone in brown or black skin is absent; light-skinned African Americans may have yellowish brown skin; dark-skinned African Americans may appear ashen or gray:

Back 227

-Pallor

Front 228

-Light Skin: Lesions appear as small, reddish-purple pinpoints, best observed on abdomen and buttocks
-Dark Skin: Difficult to see; amy be evident in the buccal mucosa of the mouth or conjunctiva of the eye:

Back 228

-Petechiae

Front 229

-Light Skin: May be visualized, as well as felt with light palpation
-Dark Skin: Not easily visualized, but may be felt with light palpation

Back 229

-Rash

Front 230

-Light Skin: Generally heals, showing narrow scar line
-Dark Skin: Higher incidence of keloid development, resulting in a thickened, raised scar:

Back 230

-Scar

Front 231

Blood is supplied to the brain by 2 major pairs of arteries:

Back 231

1.) the internal carotid arteries (anterior circulation)
2.) the vertebral arteries (posterior circulation)

Front 232

The brain is normally well protected from changes in mean systemic arterial BP over a range from 50-150 mm Hg by a mechanism known as:

Back 232

-cerebral autoregulation: this involves changes in the diameter of cerebral blood vessels in response to changes in pressure so that the blood flow to the brain stays constant

Front 233

Name the 3 factors that affect blood flow to the brain:

Back 233

1.) systemic BP
2.) cardiac output
3.) blood viscosity

Front 234

Hardening and thickening of arteries; a major cause of stroke; lead to thrombus formation and contribute to emboli:

Back 234

-Atherosclerosis

Front 235

This occurs when a cerebral artery becomes blocked and blood supply to the brain beyond the blockage is cut off:

Back 235

-Cerebral infarction

Front 236

-A series of metabolic events including inadequate ATP production, loss of ion homeostasis, release of excitatory amino acids, free radical formation, and cell death:

Back 236

-Ischemic cascade

Front 237

If adequate blood flow can be restored early and the ischemic cascade can be interrupted, there may be less brain damage and less neurologic function lost, with how much time does this need to occur?

Back 237

-Within 3 hours

Front 238

A temporary focal loss of neurologic function caused by ischemia of one of the vascular territories of the brain, lasting <24 hours and often lasting <15 minutes; most resolve within 3 hrs; may be due to microemboli that temporarily block the blood flow; S&S: depend on the blood vessel that is involved and the area of the brain that is ischemic:

Back 238

-TIA (transient ischemic attack)

Front 239

Results from inadequate blood flow to the brain from partial or complete occlusion of an artery; these account for approximately 80% of all strokes:

Back 239

-Ischemic stroke

Front 240

Occurs from injury to a blood vessel wall and formation of a blood clot; lumen of the blood vessel becomes narrowed and, if it becomes occluded, infarction occurs; most common cause of stroke (60%):

Back 240

-Thrombotic stroke

Front 241

Occurs when an embolus lodges in and occludes a cerebral artery, resulting in infarction and edema of the area supplied by the involved vessel:

Back 241

-Embolic stroke

Front 242

Account for approximately 15% of all strokes and result from bleeding into the brain tissue itself or into the subarachnoid space or ventricles:

Back 242

-Hemorrhagic stroke

Front 243

Bleeding within the brain caused by a rupture of a vessel and accounts for about 10% of all strokes; prognosis is poor:

Back 243

-Intracerebral hemorrhage

Front 244

Occurs when there is intracranial bleeding into cerebrospinal fluid-filled space between the arachnoid and pia mater membranes on the surface of the brain; commonly caused by rupture of a cerebral aneurysm:

Back 244

-Subarachnoid hemorrhage

Front 245

Motor deficits following a stroke include:

Back 245

1.) mobility
2.) respiratory function
3.) swallowing and speech
4.) gag reflex
5.) self-care abilities

Front 246

Describe characteristic motor deficits following a CVA:

Back 246

-Loss of skilled voluntary movement (akinesia)
-Impairment of integration of movements
-Alteration in muscle tone
-Alterations in reflexes
-Initial hyporeflexia (depressed reflexes) progress to hyperreflexia (hyperactive reflexes) for most patients
-Lesion on one side of the brain affects motor function on the opposite side of the brain
-Arms and legs may be weakened or paralyzed to different degrees depending on which part of and to what extent the cerebral circulation was compromised

Front 247

Describe characteristic communication deficits following a CVA:

Back 247

-Left hemisphere is dominant for language skills in right-handed person and in most left-handed persons
-Disorders involve expression and comprehension of written and spoken words
-Aphasia, dysphasia, nonfluent, fluent, global aphasia, receptive aphasia, expressive asphasia
-Dysarthria

Front 248

Total loss of comprehension and use of language:

Back 248

-Aphasia

Front 249

Refers to difficulty related to the comprehension or use of language and is due to partial disruption or loss:

Back 249

-Dysphagia

Front 250

Minimal speech activity with slow speech that requires obvious effort:

Back 250

-Nonfluent

Front 251

Speech is present but contains little meaningful communication:

Back 251

-Fluent

Front 252

In which all communication and receptive function is lost:

Back 252

-Global aphasia

Front 253

When neither the sounds of speech not its meaning can be understood:

Back 253

-Receptive aphasia

Front 254

Difficulty in speaking and writing:

Back 254

-Expressive ahasia

Front 255

A disturbance in the muscular control of speech; does not affect the meaning of communication or the comprehension of language, but it does affect the mechanics of speech:

Back 255

-Dysarthria

Front 256

Describe emotional, intellectual, spatial-perceptual, and elimination alteration for someone after a CVA:

Back 256

-Emotional: my be exaggerated or unpredictable
-Intellectual: left-brain stroke is more likely to result in memory problems related to language; very cautious in making judgments; right side tends to be impulsive and to move quickly
-Spatial: right side is more likely to cause problems
-Elimination: occur initially and are temporary; partial sensation for bladder filling remains, and voluntary urination is present; initially frequency, urgency, and incontinence; constipation is associated with immobility, weak abdominal muscles, dehydration, and diminished response to the defecation reflex

Front 257

Describe nursing actions for a patient experiencing a CVA:

Back 257

-Respiratory: frequent assessment of airway patency and function, oxygenation, suctioning, pt mobility, positioning of the pt to prevent aspiration, and encouraging deep breathing
-Neurologic: monitor neurologic status closely to detect changes suggesting extension of the stroke, increased ICP, vasospasm, or recovery from stroke symptoms
-Cardio: monitoring vs frequently, monitoring cardia rhythms, calculating I&O, noting imbalances, regulating IV infusions, adjusting fluid intake to the individual needs of the pt, monitoring lung sounds for crackles and rhonchi indicating pulmonary congestion, monitoring heart sounds for murmurs or for S3 or S4 heart sounds
-DVT: active range of motion exercises, positioning to minimize the effects of dependent edema and the use of elastic compression gradient stockings or support hose, Lovenox
-Muscle: range-of-motion exercises, trochanter roll, hand cones, arm supports, avoidance of pulling the pt by the arm to avoid should displacement, posterior leg splints, footboards, or high-top tennis shoes, hand splints to reduce spasticity
-Skin: pressure relief by position changes, good hygiene, emollients applied to dry skin, early mobility
-GI: stool softeners and/or fiber, check for impaction, physical activity
-Urinary: intermittent cath care
-Nutrition: assess swallowing ability