What Is The Procedure For Accomodation

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what is the procedure for accomodation

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is the ability of the pupil to respond to near and far distances. the pt is told to focus on an object far away. the size and the shape of the pupils are observed. the examiner observes the pupil while the pt focuses on near object holds approx 5 inches from face. normally the pts eyes turn inward and the pupils constrict (convergence and constriction)

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central hearing loss

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occurs when the cns cannot interpret normal auditory signals. this condition occurs with disorders such as cva and tumors

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myopia

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nearsightedness is caused by light rays focusing infront of the retina. the eyeball is elongated. and thus the light rays do not reach the retina. its corrected with concave lenses.

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conductive hearing loss

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is any interference with the conduction of sound impulses through the external auditory canal, the eardrum or the middle ear. can be caused by cerumen, foreign bodies, infection, perforation of the tympanic membrane, trauma, fluid in the middle ear, cysts, tumor, or otosclerosis. its a mechanical problem.

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sensory hearing loss

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originates in the cochlea and involves the hair cells and nerve endings. results from diseases or trauma to the sensory or neural components of the inner ear. some infections that cause this are measles, mumps, meningitis, ototoxic drugs, trauma, noise, arteriosclerosis

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functional hearing loss

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is a hearing loss for which there is no organic cause or lesion can be found. precipitated by emotional stress

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some age related changes for sensory system

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presbyopia, narrowing of the visual field and more difficulty with peripheral vision, decreased pupil size and responsiveness to lit, diff with dimly lit or at night, decreased opacity of the lens which causes sensitivity to glare, blurred vision, yellowing of eyes, increased time to accomodation

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retinopathy

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is a disorder in which vascular changes occur in blood vessels. (most common is diabetic retinopathy from excess glucose, changes in the retinal capillary walls. )

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The three stages of diabetic retinopathy

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Backround: involves microaneurysms form on the retinal capillary walls

Preproliferative stage: is characterized by swollen and regularly dilated veins, which result in sluggish or blocked blood flow

proliferative:is characterize by the formation of new blood vessels growing into the retinal and optic disc area in an attempt to increase the blood supply to the retina. The newly formed vessels often leak into the vitreous and retina which causes a traction effect pulling the retina away from the choroid which is also called retinal detachment

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Retinal detachment

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is a separation of the retina from the choroid layer beneath it allowing fluid to enter the space between the layers. Three causes are a hole or tear in the retina that allows fluid to flow between the two layers, fibrous tissue in the vitreous humor that contracts an pulls the retina away from its normal position or fluid or exudate accumulation in the subretinal space that separates the 2 layers.

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Glaucoma

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is a group of diseases characterized by abnormal pressure within the eyeball. This pressure causes damage to the cells of the optic nerve. The damage is silent, progressive and irreversible until the end stages when loss of peripheral vision occur, followed by reductions in central visin and eventually blindness vision occur.

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depression

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a change in mood which lasts at least 2 week and includes sadness, negativism loss of interest, pleasure and/or decline in functioning. Can last months to years if not treated. Thoughts highlight failure and sense of hopelessness

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delirium

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is an acute or sudden of mental confusion as a result of a medical, and/or environmental condition. Causes are drug toxicity, urination problems, elimination problems, changes in chronic illnesses, new disease, sleep disturbance, post-operative. Can last hours to months.

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delirium and nursing considerations

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orientation, environment; avoid room changes, decrease noise, discourage napping, communication; acknowledge the persons emotions and encourage verbal expression , explain to the person they are experiencing delirium

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dementia

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progressive decline in day to day cognition and functioning. A terminal condition. usually 8-20yrs. Gradual loss of cognition and ability to problem solve and function independently. Some facilities use Lewy body dementia to detect it.

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immune system

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the immune system no longer recognizes the body's normal cells at self. Instead antigens on these normal body cells are recognized as foreign material and the body launches a response to destroy them. (factors, viral infections, drugs, cross-reactive antibodis, microbes, hormones)

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perniscious anemia

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antibodies that destroy gastric parietal cells lead to decreased production of intrinsic factor, other intrinsic factor antibodies alter the binding sites, which ultimately decreases the ability of intrinsic factor to assist in the absorption of vit b12 in thei ileum. (causes; familial tendency, any type of gastric or small bowel resections)

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discoid lupus erytematsus

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discoid lupus erythematosus consists of only skin lesions; patchy crusty sharply defined skin plaques, tend to occur on the face or sun expsed areas.

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systemic lupus erythematosus

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is a chronic inflam. multisystem disorder. the body develops antibodies against its own tissue. s&s fatigue, fever, butterfly rash, photosensitivity, mucosal ulcers, alopecia, pain, pruritis. .. leukopenia... causes drug induced, fever, rash, arthritis

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nursing management for systemic lupus erythematosus

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avoid trigger fkares, take naps if needed, daiky schedules to avoid fatigue, maintaining fitness and joint rom, warm baths

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passive immunity

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antibodies are not produced by the person but are obtained from anither source. one form naturally acquired passive immunity includes placental transmission of antibodies in breast milk.

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artificially acquired passive immunuty

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involves injection of performed antibodies

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active immunity

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means that the person produces his ir her own antibodies, ex; when a person recovers from an infection and then has antibodies and memory cells specific for that person

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artificially acquired active immunuty

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occurs as a result of a vaccine that stimulates the production of antibodies and memory cells

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3 stages of cancer

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initiation: when a person is introduced to the carcinogen which causes an alteration in the genetic structure of the cell. promotion: it occurs after repeated exposure to carcinogens causes the initiated cells to mutate. metastasize: when the cell becomes cancerous and metastasizes.

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C.A.U.T.I.O.N

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c:change in bowel or bladder habits A: a sore that dies not heal U: unusual bleeding or discharge T: thickening of lump in breast or elsewhere I: indigestion or dysphagia O: obvious change in a wart or mole N: nagging or persistant cough

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grading tumor

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defines cell types of tumor, classified as % of differentiated cells. the more differentiared cells the more cancerous it is and the cell becomes more unrecognizable to what type of cell it is.

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staging

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defines the stage of tumor by the type. the higher the stage the more te cancer has spread

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cancer classifications

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are identified by the tissue it is affected, soeed of growth, cell appearance, location. cancer

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carcinoma, sarcoma, lymphoma

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carcinoma: includes the cells of the skin, gi system and lungs.
sarcoma: con. tissue, fst, the sheath of the nerves, cartilage, muscle, bone
lymphomas: lymph nodes, spleen

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uremia

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waste products builiding up in the blood

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urinary retention

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is the inability to empty the bladder completely

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uti

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an invasion of the urinary tract by bacteria
lower uti's urethritis, prostatitis, stystitis
upper uti's are pyelonephritis, ureteritis, these infections might result in chronic kidney dusease, sepsis, or damage to the kidney

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cystitis

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inflammation of the bladder wall

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pyelonephritis

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is infection of the renal pelvis, tubules, and interstitial tissue of one ir more kidneys

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oliguria

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less than 400ml of urine in 24hrs

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chronic kidney disease

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is a progressive, irreversible deterioration in renal function in which the body is unable to maintain metsbolic, fluid, and electrolyte balance, when the lg portion of the nephrons are damaged or destroyed acute kidney injury or chronic kidney disease occurs. and increase the work for the remaining nephrons.
early stage: 50% nephrons damaged asymptomatic
renal stage insufficiency: up to 75% nephron function lost, anemia, and the inability to concentrate urine occur. these pts are at high risk for further damage caused by infection, dehydration, drugs or heart failure.
end stage: 90% nephron function lost, these pts make urine but do nit filter out waste product or urine production may cease.

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s&s of chronic renal disease

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cv: htn due to fluid overload, lt ventricle failure, edema, angina due to CAD
GI: stomatitis due to fluid restriction and waste product in mouth, anorexia, NV due to uremia, gastritis/GI bleeding, constipation due to electrolyte imbalance, diarrhea
hematopoietic: anemia, bleeding tendency, prone to infection
integumentary: dry itchy skin, pale yellow skin, urine smelling, decreased function of oil and sweat glands
neurologic: confusion, cva,
reproductive: loss of libido, impotence, amenorrhea, infertility
skeletal: bone and mineral disease

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nursing care plan for pts with chronic renal failure

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monitor. .. wt, I&o, vital signs, SOB, crackles in lungs, frothy sputum, heart ireegularities, cold clammy skin, maintain sodium and fluid restrictions, observe skin for open areas, and signs of infection, bathe with tepid water with oils or oatmeals. apply lotion, assess for signs of bleeding, have pt space out activities,

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bph

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is an enlarged prostate gland

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appendicitis

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inflammation of the appendix, obstruction may occur making it susceptible to infection.

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peritonitis and causes

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is inlam. of the peritoneum. causes: ruptured appendix, perforation of peptic ulcer, gangrenous gallbladder, instestinal diverticula, caused by leakage.

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s&s of appendicitis

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abd. pain @ the site of the perforation or leakage, tender and aggravated by movement, rebound tenderness, and abd rigidity, decreased peristalsis

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diverticulum

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is a hermiation or outpouching of the bowel mucous membrane cause by increased pressure within the colon and weakness of the bowel wall

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diverticulosis

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is a condition in which multiple diverticula are present without evidence of inflam. chronic constipation is usually the cause. when the pt is chronically constipated, pressure within the bowel is increased leading to development of divertiula.

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diverticulitis and s&s

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when food and bacteria get trapped in the diverticulum, infection and inflam occur. s&s: bowel changes maybe alternating between constipation and diarrhea, steady or crampy pain in LLQof abd. as it worsens bleeding may occur with weakness fever, fatigue, and anemia.
VS are monitored for fever and signs of septic shock, pain, i&o are monitored, bp...

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crohns disease

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is an inflam. disease of the bowel that can involve any part of the GI. when the inflam. occurs it may lead to fistulas, fissures, and abscesses. tends to occur within families, autoimmune processes or infectious agents

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s&s of crohns disease

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crampy abd pain, wt loss, malnutrition, pts avoid eating, fissures, fistulas, and abscesses, symptoms outside of gi are arthritis, skin lesions, inflam. disorders of the eyes, abnormalities of liver function
diet, lifestyle changes, meds, (anti inflam, antibiotics, immunosupressives) high fibre foods, milk products, caffeine, spicy foods are avoided.

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ulcerative collitis

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inflam occurs in the lg colon and rectum. multiple ulcerations occur and diffuse. a pt with this have a risk of developing colorectal cancer.
causes: infection, allergy, autoimmune responses, environmental agents
similar to crohns, vomiting, 5-20 stools a day, rectal bleeding,

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hermia

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is a abnormal protrusion of an organ or structure through a weakness, or tear in the wall of the abd wall.
weakness in abd wall, along with increased intra-abd pressure from coughing, straining and heavy lifting (obesity, pregnancy and poor wound healing are all risk factors)

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hiatal hernia a condition in which the lower part of the esophagus and stomach slides up through the hiatus of the diaphragm into the thorax. a sliding hiatal hernia is in which the stomach slides up into the thoracic cavity when a pt is supine and usually goes back into the abd cavity when standing upright. people with hiatal.h usually have GERD as well.

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hiatal hernia

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s&s and nursing considerations of a hiatal hernia

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a sm. hernia may nit produce any discomfort or require tx however lg ines can cause pain, heaetburn, a feeling of fullness, or reflux
taking antacids, eating sm. meals that easily pass through esophagus, not reclining for 1hr after eating, drinking after eating not during,

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GERD and causes

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is a condition in which gastric secretions reflux back into the esophagus, which then can damage the esophagus by acidic secretions and exposure to digestive enzymes.
conditions that affect the ability of the lower esophageal sphincter to close tightly such as hiatal hernua

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s&s of GERD

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heartburn, regurgitation, dysphagia, bleeding. aspiration is a concer, scar tissue can develop from inflam.

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nursing considerations of GERD

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identify factors that increase pain, monitir it,instruct ot to elevate head of bed 4-6 in when sleeping, eat sm. meals, avoid lying down for 2 hrs after eating, instruct pt to take meds even if symptoms are relieved,

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hemorrhoids and causes

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are enlarged veins within the anal tissue.caused by an increase in pressure in the veins often from increased unta abd pressure, straining during BM, common during pregnancy, prolonged sitting, standing, obesity and chronic constipation.

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ostomy

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is a surgically. created opening that diverts stool or urine to the outside of the body through an opening of abd called stoma

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stoma

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is the portion of the bowel that is sutured onto the abd

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ileal conduit

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method of diverting the urinary flow by transplanting the ureters into a prepared and isolated segment of the ileum, which is sutured closed on one end. the other end is connected to a stoma in the abd wall.

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macular degeneration

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eye disorder caused by degenerationg of cells in the macula, results in blurred vision can cause blindness

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otosclerosis

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a hereditary disorder causing progressive deafness due to overgrowth of bone in the inner ear

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sjogrens syndrome

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a chronic auto immune condition cgaracterized by degeneration of the salivary gland and lacrimal glands
dryness of mouth and eyes

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sundowning syndrome

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nocturnal confusion, has to do with mental state