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Fourth Semester > Adult Care Exam 3 > Flashcards

Adult Care Exam 3 Flashcards

(124 cards)

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1
Q

What occurs to the lens of the eyes when a patient develops cataracts?

A

lens become dense through loss of water, causing an increase in the opacity of the lens (cloudiness), blocking rays of light from entering the eye

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2
Q

What are some risk factors for cataracts?

A

UV Light Exposure

Glaucoma/ Genetics
Age (most common)
Trauma
Health conditions (Diabetes, HTN, hyperlipedemia)
Exposure (corticosteroids, alcohol, smoking)
Retinal Detachment

” U GATHER!”

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3
Q

Are cataracts natural and normal?

A

Yes, they are a normal part of aging

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4
Q

What are some vision changes with cataracts?

A

Cloudy/blurry/double vision
Around lights there are halos
Toned down colors
Sensitivity to glare and light (difficulty seeing at night)

CATS

visual sensory perception is reduced

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5
Q

What is NOT associated with aging cataracts? What are the first signs?

A

Pain or eye redness. First signs include slight blurred vision and decreased color perception

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6
Q

What do vision changes of cataracts lead to?

A

blindness

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7
Q

What are some measures to prevent cataracts?

A

Wearing hats and sunglasses (with UVA & UVB protective coating) when in the sun.
Smoking cessation
Eat a low-fat diet rich in antioxidants and vit. E & C
Avoid ocular injury (wear goggles when using power tools)

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8
Q

Pre op Teaching for cataracts include…

A

Assess how vision affects ADL’s
Phenylephrine (to dilate pupils)
Bromfenac (NSAID eyedrop for pain relief)
Valium to decrease nerves
Informend consent for the procedure
Are they on blood thinners or Tamulosin?
Clip eyelashes
Measures to decrease increased IOP
NPO
Void before procedure

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9
Q

You look through your patients chart and notice they are taking Heparin, Asprin, and Tamulosin. What should you do?

A

Notify the provider. Taking blood thinners can cause hemorrhage during the procedure. Taking Tamulosin when undergoing eye surgery can prevent the pupil from dilating properly, causing floppy eye syndrome.

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10
Q

What must all patients have in regards to cataract surgery?

A

some type of replacement lens: intraocular implanted lens, contact lens, eyeglasses

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11
Q

What are some post op nursing intevertions for cataract surgery?

A

Raise HOB
Avoid laying on affected side (lay on the other side or on back)
Monitor for N/V –> d/t increase IOP
Prednisone to reduce inflammation (corticosteroid)
Ciprofloxacin and Mozifloxacin (ABX)
Pilocarpine to constrict the pupil
Minimal light –> wear UVA sunglasses
Avoid straining/ sneezing/ coughing
Educate on when and how to admin eyedrops
Educate to not drive/ operate heavy machiner
Wear an eye shield at night for 2-3 weeks

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12
Q

What is normal post op for cataract surgery? What is abnormal?

A

some redness, irritation and blurriness is normal
pus/ swelling, pain, decrease in vision, floaters, excessive redness is abnormal

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13
Q

What are the different types of cataract surgery?

A

intracapsular- removal of the lens and its capsule through wide incision in cornea

extracapsular- Contents of lens aspirated by large-bore needle thru small incision in cornea, leaving posterior portion of lens capsule behind. IOL placed there

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14
Q

The patient is taking prednisone and they report of pressure in the eye and you notice edema. What should you do as the nurse?

A

alert the provider

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15
Q

The patient is displaying s/s including pain early after surgery, pain with nausea and vomiting, are these expected findings?

A

No! Notify the provider. Pain early after surgery indicated increased ocular pressure, infection, or hemorrhage.

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16
Q

A patient post op cataract surgery asks you if they can blow their nose. What should you say as the nurse?

A

No, blowing your nose, bending forward, or straining can increase intraocular pressure (IOP). Do not do any type of straining for a few days after surgery.

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17
Q

A patient who just underwent eye surgery was admitted to the hospital d/t an MI. What should the nurse do?

A

make sure they get their eye medication, as they must take it as prescribed

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18
Q

What is glaucoma?

A

Diseases that damage the optic nerve. Commonly d/t an increase in the intraocular pressure. S/s include blurred vision, HA, halos around lights, eye redness, loss of peripheral vision

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19
Q

How soon does glaucoma need to be diagnosed?

A

EARLY to prevent vision loss, cant reverse damage that has occured but can control IOP

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20
Q

What type of glaucoma is most common? What is the patho?

A

Open angle
obstruction in the flow of virterous humor of the eye –> increased IOP–> damage to nerve fiber–> loss of vision

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21
Q

What is the recommended screening schedule for glaucoma?

A

2-4 years before 40
1-3 years between 40-54
1-2 years between 55 and 64
6-12 years over 65

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22
Q

How does a provider diagnose glaucoma?

A

comprehensive dilated eye exam

measure IOP and visual acuity (air blown in eye) tonometry

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23
Q

What happens when glaucoma is left untreated?

A

leads to complete loss of visual sensory perception

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24
Q

What are the two types of glaucoma?

A

Open angle glaucoma
Angle Closure Glaucoma

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25
Is open angle glaucoma a slow or fast onset?
slow onset of elevated IOP mild eye pain commonly affects both eyes with no s/s in early stages Treat with Beta B and cholinergics
26
Is angle closure glaucoma a slow or fast onset?
Rapid onset of elevated IOP severe pain and nausea Medical emergency Treat with IV or PO Diamox (diuretic) plus topical beta blocker and miotics, then surgery ## Footnote we use a diuretic to get rid of the increased fluid FAST
27
What are the opthalmic agents used to treat glaucoma?
adrenergic (purple lid) beta blocker (blue/ yellow lid) miotics/ cholinesterase inhibitors (green lid) carbonic anydrase inhibitors (orange lid) prostaglandin analogues (teal lid)
28
What is the antidote for cholinergics used to treat glaucoma?
atropine
29
With open angle glaucoma, how should you take your medications?
Stick to a strict medication routine, space them every 5 minutes apart. Apply to the conjunctival sac, avoid blinking, apply pressure to the eye. Eye drops first then apply ointment.
30
A patient is taking a beta blocker with a blue/ yellow lid. What s/s should you alert the provider of?
bradycardia, CHF, syncope, bronchospasms, depression, confusion, sexual dysfunction
31
How do beta blockers treat glaucoma?
decreases production of aqueous humor
32
What should you do as the nurse to monitor the patient for adverse effects when taking BetaB?
monitor v/s, cognitive awareness, respiratory status
33
Why should you use caution using a beta blocker in these specific patients...?
Asthma, DBM and CHF patients, can cause vasodilation
34
What medications are in the adrenergic class (purple lid)
lopidine, alphagan, epinal
35
What should you monitor for when giving lopidine, alphagan, or epinal?
palpitations, HTN, tremor, sweats
36
What nursing interventions will you use when monitoring for side effects of lopidine, alphagan, or epinal?
monitor V/S, neuro function, and respiratory status
37
What class of medication does pilocarpine or humorsol belong to ?
miotics/ cholinesterase inhibitors (green lid)
38
How does cholinergic- miotic (pilocarpine) treat glaucoma?
constricts pupil --> open canal and increases flow of aqueous fluid
39
What should you teach your patient to watch for when taking pilocarpine/ humorsol?
bronchospasms, salivation, nausea, vomiting, diarrhea, abdominal pain, lacrimation ## Footnote cholinergic effects
40
What nursing interventions should you implement when administering pilocarpine/ humorsol?
monitor V/S, bowel pattern, pain level, tear production
41
Whats the difference in timolol and pilocarpine?
pilocarpine helps by improving fluid drainage, timolol reduces fluid production. both lower eye pressure, and they may be used together
42
What medications belong to the carbonic anhydrase inhibitors class?
dorzolamide hydrochloride (Trusopt) and Brinsolamide (Aspot) (orange lid)
43
A patient taking Trusopt/ Asopt is exhibiiting s/s of fatigue, renal failure, hypokalemia, diarrhea, depression, and COPD exacerbation. What is your priority action as the nurse?
Alert provider
44
What nursing interventions will you implement when administering a carbonic anyhdrase Inhibitor?
monitor V/S, Potassium levels, bowel patterns, COPD management
45
What medication class does Latanoprost (Xaltan) and Bimatoprost (Lumigan) belong to?
Prostaglandin Analogues (teal lid)
46
When administering Latanoprost/ Bimatoprost, what s/s would you need to report to the provider? What nursing interventions would you implement?
changes in eye color, periobirtal edema, itching; monitor eye color, edema and itching
47
What are the s/s of a detached retina? When does the patient typically have the s/s?
small flashes (shooting stars), thin lighting streaks, **floaters**; *curtain* like shadow reduced peripheral vision mainly seen in a dark room with affected eye
48
What is a gas bubble in relation to a detached retina? What should you teach the patient for it?
a gas bubbles helps reattach the retina by pushing it into the back of the eye; keep head in position instructed by surgeon to promote reattachment; report nausea and vomiting, changes in vision, or pain
49
What should you teach a patient who has macular degeneration?
stop smoking, manage diabetes, HTN, cholesterol wear ultraviolet sunglasses excercise routinely increase intake of neccessary vitamins
50
What is an important nursing intervention for patients with macular degeneration?
Can they perform ADLs/ read medication labels
51
What vitamins do you need to take for macular degeneration? How often do you take them?
Zinc oxide Cupric oxide Beta carotene (lutein and zeaxanthin) Vitamin C Vitamin E Divided doses BID ## Footnote Can Zebras Eat Betacarotene carrots
52
What kind of foods have zinc oxide?
Ogres prefer big red nipples oysters, red meat, poultry, beans, nuts/seeds
53
What foods have cupric oxide?
Lazy snails nibble on luscious donuts liver, shellfish, nuts seeds, legumes, dark chocolate
54
What foods contain beta carotene? What vitamin in the body is it converted into?
Crazy squirrels steal mens dirty butts carrots, sweet potatoes, dark leafy greens, butternut squash, mangoes Vitamin A
55
What foods contain vitamin C?
Kinky cats brings sexy berries and broccoli Kiwi, Citrus fruits, bell peppers, strawberries, broccoli
56
What are the 2 types of age related macular degeneration (ARMD)?
Dry (atrophic) age related macular degeneration Wet (neurovascular exudate) age related macular degeneration
57
What foods contain vitamin E?
Naughty vegans steal all of the fish nuts and seeds, vegetable oils, spinch, avocado, fish
58
What occurs to the eye during wet ARMD?
abnormal blood vessels behind the eye leak fluid, causing the macula to move from the original position
59
What occurs to the eye during dry ARMD?
light sensitve cells (deteriorate) break down causing blurry vision ## Footnote 85-90 % of cases is dry ARMD
60
What is the leading cause of blindness in patients over 65 and causes a loss of central vision?
ARMD
61
What are drugs with a risk of hearing changes?
Aminoglycoside ABX -mycin (ototoxic) Antineoplastics - cisplatinum (ototoxic) Loop diuretics -furosemide (ototoxic) BB - propanolol (tinnitus and hearing loss) ASA and NSAIDs (tinitus)
62
How do you care for a hearing aid?
Remove and clean at bedtime No alcohol or harsh soap Use cotton pad or cloth with saline/ water Disengage battery Carefully remove ear wax
63
How do you communicate with an older adult with hearing loss?
Dont scream. Talk low and slow
64
What are the nonmodifiable/ modifiable causes of COPD?
smoking, allergen exposure, exercise, genetics, altitude, chronic diseases
65
With what illness can air not get in, and only out = wheezing?
Asthma
66
Whats the difference between chronic bronchitis and emphysema?
blue bloaters (bronchitis) and pink puffers (emphysema)
67
What is the clinical diagnosis of chronic bronchitis?
daily productive cough for 3 months or more, in at least 2 consecutive years
68
What is the patho behind emphysema?
permanent enlargment and destruction of airspaces distal to the terminal bronchiole
69
What are s/s of blue bloater?
overweight and cyanotic elevated Hgb peripheral edema rhonchi and wheezing
70
What are the s/s of pink puffers?
older and thin severe dyspnea quiet chest x-ray - hyperinflated with flattened diaphragms
71
What are some ways to improve pulmonic function?
breathing relaxation techniques smoking cessations energy conservation excercise group support
72
What are some management techniques of COPD exacerbations?
bronchodilators, oral steroids, ABX (sputum volume, color change, and fever) noninvasive intermittent positive pressure ventilation improves blood gases and decreases need for ventilator
73
What are some oxygen therapy considerations and safety?
long term admin of O2 (>15 hrs per day) to patients with chronic respiratory failure long term O2 therapy for severe hypoxemia safely use O2 to prevent narcosis and respiratory depression
74
What is the ONLY treatment shown to alter course of advanced COPD?
O2
75
What are s/s of oxygen tox?
decreases vital capacity edema cough sputum substernal pain fibrosis N/V Paresthesia nasal stuffiness sore throat malaise
76
What pt teaching points will you give to asthmatic patients?
drink plenty of fluids take prednisone w food use leukotriene antagonists (montelukast) to* prevent* asthma attacks use good mouth care do not stop the anti inflammatory meds suddenly
77
What are some pt teaching points for COPD patients?
S/s of infection Proper hydration, use of O2, and meds - MDIs and spacers (older adults’ benefit) Immunizations (influenza and pneumococcal vaccination) Climate- avoid high temperatures and humidity
78
What are physical s/s of elder abuse?
Infliction of pain Depriving of rood Over/under medication restraints
79
What are s/s of psychological abuse?
Infliction of mental anguish Name calling Immediate and threatening individual Behavior may cause fear, mental anguish, and emotional pain/distress saying someone needs a wheelchair and saying they are weak when not needed
80
What are s/s of financial abuse?
Illegal/improper exploitation and/or use of funds or resources Fraud Taking money under false pretenses Forgery (especially during surgery or has heart attack—wants to sign will and claim money) Spending the older adult's money without knowledge or permission
81
What are s/s of sexual abuse in elderly adults?
Non-consensual contact of any kind with an older person Sexual exhibition Rape Inappropriate touching Any unwanted sexualized behavior
82
What are s/s of caregiver neglect in elderly patients?
Refusal or failure to fulfill a care-taking obligation Intentionally failing to meet the physical, social, or emotional needs of the older person Failure to provide food, water, clothing, meds Assistance with activities of daily living Help with personal hygiene
83
Who is the victim and usual abuser in elder abuse?
Elderly white women who cannot care for herself is the most common victim older than 80 years
84
What increases the r/f abuse in elderly patients?
At home care, care by family or caregiver Highest reports from family Isolation, mental illness/alcohol/drug abuse Living with elder, caregiver stress Adult daycare When perpetrator is spouse, may be domestic violence
85
What is the role of the nurse in elderly abuse?
mandated reporter
86
What should you do when a patient says “my cousin is coming over today” but their cousin is dead?
ask about their cousin and favorite memories, don’t remind them that their cousin is dead.
87
What are normal age related increased changes r/t memory?
Increased reaction time and slowed responses and movements, pain threshold, coordination, incidence of physiologic tremor (benign senile tremors)
88
What are normal age related decreased changes in r/t memory?
Decreased vibratory sensation in lower extremities, sensation to light, touch, pain, joint position Some deep tendon reflexes absent in older people Depression and mood disorders become more common with aging Decreases in short-term memory and increased incidence of benign process of deterioration of aging , blood flow to brain, decrease brain size/weight
89
What mood disorders are more common in older adults?
Depression, insomnia and mood disorders become more common with aging
90
What is stage 1 of Alzheimers Disease?
normal adult - no cognitive decline
91
What is stage 2 of Alzheimers Disease?
normal older adult- mild memory loss
92
What is stage 3 of Alzheimers Disease?
early dementia- unable to remember names of people
93
At what stage (out of 7) do patients with Alzheimers need help with ADLs?
Stage 4, Mild dementia- difficulty with finances, counting money, memory loss of current and recent events
94
What is stage 5 of Alzheimers Disease?
moderate dementia- begins to need more assistance
95
What is stage 6 of Alzheimers Disease?
moderately severe dementia- forgets names of family members, requires more assistance with ADLS, experiences delusions, hallucinations, increased anxiety, can become violent, sleeps more during the day
96
What is stage 7 of Alzheimers Disease?
severe dementia- all speech is lost, lose urinary and bowel control. cannot walk, bedridden
97
You need two of what to be diagnosed with dementia?
significantly impaired cognate functions (memory, communication/language, attention span, reasoning and judgment, visual perception)
98
What are the emotional s/s of depression?
sadness, diminished ability to be joyful, inability to concentrate, recurrent thoughts of death & excessive guilt over past things
99
What are the physical s/s of depression?
body aches, HA, pain, fatigue, changes in sleep & weight loss/gain
100
What medications treat the s/s of Alzheimers ?
Cholinesterase Inhibitors, NMDA inhibitors, Antioxidants
101
What medication is a cholinesterase inhibitor? What is the major s/e?
Donepezil, Rivastigmine, Galantamine. Used for mild-moderate dementia, including vascular dementia and Lewy body
102
What drugs are NMDA inhibitors?
Memantine for moderate- severe Alzheimers disease. It is the only drug that can be added to other meds
103
What medications to treat Alzheimers are antioxidants?
Vitamin E : prevent or delay Alzehimers development Gingo Biloba: treatment of memory disorders, improving blood flow to brain. S/e: bleeding, nausea, anxiety, GI disturbances, headache
104
How do antioxidants work?
Free radicals are produced when the body breaks down food. Negative chaged particles are the result of oxidation. Free radicals damage cells. Antioxidants can stop destruction by being oxidized themselves Free radicals (troublemakers) Antioxidants (cops that protect the city)
105
How do you best communicate with someone with dementia?
reassure the pt, use a calm tone
106
What management strategies for aggression/ agitation?
Do not physically restrain, go into their world and figure out what calms them Help the person finish the task Engage them in a new activity where he will be successful such as folding towels
107
What do NSAIDs do in r/t Alzheimers?
lower rate of Alzheimers
108
What is fronto-temporal dementia?
Vascular dementia, similar to drunk (dancing on tables), only affects younger people and has been linked to certain genes. Frontal and temportal lobe deteriorates
109
What is sundowning?
confusion that occurs in the night w pts who have dementia
110
How do you help sundowning?
stick to a schedule, arrange times to do activities when pt is at best, use reassuring words and encouragement, aim to keep the pt active throughout the day
111
What is respite care?
Respite care provides family caregivers with the relief necessary to maintain their own health, bolster family stability, keep marriages intact, and avoid or delay much more costly nursing home or foster care placement
112
How can you help caregivers who are stressed?
Fear/uncertainty- allow them to talk Change in family dynamics Change in family living situation Financial burdens Learning to care for family member-assist with ADL’s, treatments, recognize crisis’s Learn about restrictions and may need help adjusting their own lifestyle May cause distance between family members.
113
What paperwork needs to be in place to be a caregiver?
legal docs (advanced directives, power of attorney, living will) health info (med hx, med list, healthcare providers)
114
What is the purpose of the caregiver strain index?
Assists nurse in determining the degree of caregiver strain of carers, assess their ability to go on caring and to identify areas where support may be needed. If you have a caregiver that has comorbidities and you notice a decline in their health; perform the caregiver strain index and if they score more than a 7 they need respite care. Care giver strain can cause elder abuse or abandonment
115
How do you test for depression?
Geriatric depression scale (GDS) 30-item (long) or 15-iten (short) Yes/No questions Pt. can complete alone, or have read to them Successfully distinguishes between non-/depressed older
116
When is depression normal?
Never, but its very common
117
What meds are used to treat depression?
MAOIs, SSRIs
118
What meds are in the SSRI class?
Escitalopram (Lexapro) and Citalopram (Celexa)
119
What meds are MAOIs?
Phelezine, Selegiline
120
What labs do you need to know about SSRIs?
Serum potassium Serum magnesium These meds effect QT interval/HR Full effectiveness can take 2 weeks or more
121
What do you need to monitor for MAOIs?
Assess LOC Assess BP Should be held 10-14 days before surgery Allergies to adhesives
122
What do you need to educate your patient who is taking an SSRI?
GI symptoms Anorgasmia, low sexual drive Headache Weight gain Younger patients have increased *risk of suicide * SE will mostly wain off over time (first 2 weeks are the worst) Slow onboarding (1/2 does for 1-2 weeks then full dose)
123
What pt teaching points will you give to a person taking MAOIs?
Monitor blood pressure Monitor heart rate Avoid with pregnancy Avoid tyramine rich foods
124
What is the duration of time to efficacy with SSRIs and MAOIs?
takes up to 2 weeks

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