Complex Final Exam New Info Flashcards
(262 cards)
1
Q
What happens to the lens of the eye with cataracts?
A
clouding
2
Q
What do cataracts interfere with?
A
the ability to see images clearly
3
Q
What does glaucoma increase?
A
intraocular pressure (IOP)
4
Q
What is normal IOP?
A
10-20
5
Q
What type of vision is lost with glaucoma?
A
peripheral vision
6
Q
Which type of glaucoma is most common?
A
open-angle
7
Q
What type of vision is lost with macular degeneration?
A
central vision
8
Q
What are the characteristics of DRY AMD?
A
- more common
- gradual blackage
- painless
9
Q
What are the characteristics of WET AMD?
A
- less common
- more severe
- rapid onset
- thin blood vessels leak blood/fluid
10
Q
What should you use to examine the eye with cataracts?
A
- snellen chart
- ophthalmoscope
11
Q
Should the light be increased or decreased in the room of someone with cataracts?
A
increased
12
Q
What adaptive devices can be used for cataracts?
A
- magnifying lens
- large print books
- talking clock
13
Q
What should you monitor for post-cataract surgery?
A
nausea and severe eye pain
14
Q
What should you assess with glaucoma?
A
visual acuity and visual fields
15
Q
When talking to a patient with MD, what should you do?
A
- introduce yourself and say goodbye
- make eye contact
16
Q
What assistive devices can be used for MD?
A
- braille
- audiobooks
- text-to-speech
17
Q
What is atropine 1% ophthalmic solution used for?
A
cataracts
- prevents pupil constriction
- relaxes muscles in the eye
18
Q
What is timolol used for?
A
open-angle glaucoma 1st line tx
- decreases IOP
19
Q
What are some side effects of timolol?
A
- bronchoconstriction
- hypoglycemia
20
Q
What is pilocarpine ophthalmic solution used for?
A
open-angle glaucoma
- pupil constriction
- increases circulation
21
Q
What is the antidote for pilocarpine ophthalmic solution?
A
atropine
22
Q
What is the side effect of the pilocarpine ophthalmic solution?
A
blurred vision
23
Q
What are the “-mide’s” used for in open-angle glaucoma?
A
decreases IOP
24
Q
What is IV/oral mannitol used for?
A
closed-angle glaucoma
- emergency tx to decrease IOP
25
What medications slows the rate of vision loss in macular degeneration?
intravitreal injectable drugs (antiangiogenic)
- bevacizumab
- ranibizumab
26
When should you get eye exams with cataracts?
annually
27
When should you avoid driving with cataracts?
at night
28
When should those aged 40-64 get dilated eye exams for glaucoma?
every 2-4 years
29
When should those over 65 y/o get dilated eye exams for glaucoma?
every 1-2 years
30
How long do those with glaucoma have to use eyedrops?
lifelong
31
How should you instill eye drops for glaucoma?
- one drop each eye 2 times/day
- wait 5-10 minutes between drops is more than one is needed per eye
- do not touch applicator to eye
- apply pressure to inner corner of eye and pinch eyelid closed after instilling
- wash hands before and after
32
What vitamins are important for cataracts?
C and E
33
What vitamins are important for MD?
C, E, B12, beta-carotene, zinc, copper, carotene (Vitamin A)
34
What foods are high in carotene (vitamin A)?
- orange/yellow fruits & veggies
- apricots, carrots, yams, squash, cantelope
35
What kind of pain is felt with peripheral neuropathy?
aching, shooting, burning
36
What happens to the extremities with peripheral neuropathy?
numbness, tingling
37
What is felt in the feet and hands with peripheral neuropathy?
pins, needles
38
What vitamin should you increase your intake of with peripheral neuropathy?
vitamin B12
39
What is important with foot care?
- test water temp with hand
- close-toed shoes
- NO lotion
- massage (UNLESS DIABETIC)
- avoid repetitive motion and prolonged pressure
- guided imagery, relaxation techniques
- look at feet daily
40
What forms on the myelin sheath with MS?
plaques
41
What is myelin replaced with in MS?
glial scar tissue
42
How does MS affect the eyes?
- loss of vision
- diPloPia (double vision)
- nystagmus
43
What is Uhtoff's sign (MS)?
decreased motor function and worsening of vision after being in heat (hot bath/shower)
44
How can the Romberg test be used for MS?
to assess balance because loss of balance is a symptom of MS
45
How does MS affect the brain?
- fatigue/brain fog
- mild depression
- ataxia (impaired coordination)
46
How does MS affect the muscles?
- impairment of the trunk/limbs
- spasticity
47
How does MS affect the extremities?
- numbness/tingling/pain in extremities
- fine tremors of the fingers
48
What immunosuppressants decrease the frequency of relapse in MS?
- azathioprine
- cyclosporine
49
What does the steroid prednisone do in MS?
decrease inflammation
50
What antispasmodics can be used to treat spasticity and stiffness with MS?
- dantrolene
- baclofen
- diazepam
51
What is carbamazepine used for with MS?
paresthesias
52
How is propranolol used in MS?
to treat tremors
53
What does CSF show increases in for MS?
- protein
- WBC (slightly)
54
What does an MRI show in someone who has MS?
lesions/plaques of the brain and spine
55
Who should a patient with MS be referred to for problems with walking?
PT/OT
56
What are the classic symptoms of Parkinson's Disease?
- tremors
-muscle rigidity
- shuffling gait
- bradykinesia
- shakiness
57
What neurotransmitters are involved with Parkinson's?
- increased acetylcholine (tremors)
- decreased dopamine
58
Why should you slowly increase Levodopa?
to avoid resistance
59
How does Levodopa affect bodily fluids?
turns them dark
60
What is a side effect of amantadine?
drowsiness
61
What type of food should you avoid with Parkinson's? What should you eat more of?
- avoid high-protein foods
- increase calories
62
What type of chair should someone with Parkinson's sit in?
an upright chair to facilitate standing and sitting and for eating and drinking
63
Who should a patient with Parkinson's be referred to for LTC?
PT
64
What type of foods should someone with Parkinson's eat if swallowing is affected?
thick foods
65
How should you speak to someone with Parkinson's?
slowly with frequent pauses, using alternative communication if needed
66
Why should you space out meds and protein intake with Parkinson's?
they compete for space
- LEVadopa does not LEAVE enough room for protein
67
What are the characteristics of normal cartilage?
smooth, white, translucent
- can withstand wear and strain
68
What are the characteristics of osteoarthritis cartilage?
dull, yellow, granular
69
How does cartilage get damaged?
by injury or use, destruction outweighs production
70
What happens to the bones when there is damaged/no cartilage?
they rub against each other, causing the synovium to become inflamed
71
When does joint pain occur with OA?
during motion/activity
72
When does joint stiffness occur with OA?
after rest/static positions, "early morning stiffness"
73
Crepitation occurs with OA. What is crepitation?
bones rubbing together
74
What forms osteocytes in the hands and fingers?
Heberden's nodes and Bouchard's nodes
75
What things should you assess for OA?
- pain
- functional limitation
- gait
- fatigue & pain after activity
- ROM
- anxiety/depression
76
What should be used to protect the joint and encourage use of larger joints?
splinting
77
What exercises should someone with OA participate in?
- low impact: walking
- strength training: weights
- ROM
- NO high impact: running
78
When should you do high-energy activities? When should you take meds (OA)?
- high energy activities in the morning
- take meds before activity
79
What should heat be used for (OA)?
pain
80
What should cold be used for (OA)?
inflammation
81
What assistive devices can be used for OA?
- elevated toilet seat
- shower bench
- long-handed reacher
- shoe horn
82
How long does acute back pain last?
4 weeks or less
83
How long does chronic back pain last?
greater than three months with repeated episodes of pain
84
How can back pain affect the hips, legs, and ankles?
paresthesias, pain, weakness
85
What is the leading cause of work disability?
back pain
86
Is acetaminophen helpful for back pain?
NO
87
What should be used instead of acetaminophen for back pain?
NSAIDS, mild opioids if NSAIDS do not work
88
Why are topical medications beneficial for back pain?
they can dull pain by using heat or cold
89
What are proper body mechanics for lifting?
with legs, not back
90
How should someone with back pain sleep?
- on a firm mattress
- semi-fowlers position
- pillow under flexed knees
- NO stomach sleeping
91
What medication should someone with back pain take daily?
aspirin
92
What causes a hemorrhagic stroke?
a ruptured artery or aneurysm
93
Where does bleeding occur with a hemorrhagic stroke?
inside and around brain tissue
94
What are the two types of ischemic stroke?
thrombotic and embolic
95
What causes a thrombotic stroke?
a blood clot or atherosclerotic plaque that gradually shuts off the artery
96
What causes an EMBolic stroke? (think EMBarking on an adventure)
an embolus travels to a cerebral artery
97
What is a TIA a warning sign for?
an impending stroke
98
How long do symptoms of a TIA last, and how many progress to a stroke?
- s/sx last more than 1 hr
- 1/3 progress to stroke
99
What are visual disturbances, dizziness, slurred speech, and weak extremity manifestations for?
TIA
100
What are common s/sx of stroke? (FAST)
F: face - drooping, uneven smile
A: arms - numbness, weakness
S: speech - slurred speech
T: time - act fast, record onset and duration of stroke
101
What are the 4 "A's" of left brain damage?
- aphasia (expressive and receptive)
- agnosia
- alexia
- agraphia
102
What are expressive and receptive aphasia (L brain damage)?
- inability to speak
- inability to understand language
103
What is agnosia (L brain damage)?
inability to recognize familiar objects
104
What is alexia (L brain damage)?
difficulty reading
105
What is agraphia (L brain damage)?
difficulty writing
106
When LEFT brain damage occurs, which side of the body experiences hemiplegia or hemiparesis?
the RIGHT side
107
What is hemiplegia (stroke)?
paralysis
108
What is hemiparesis (stroke)?
weakness
109
What is hemianopsia (stroke)?
loss of visual field in one or both eyes
110
When the RIGHT side of the brain is damaged, the patient may experience unilateral neglect syndrome. What happens with this?
- ignoring the LEFT side of the body
- inability to see, move or feel affected extremity
- clenched fingers
- contracted extremities
111
When RIGHT brain damage occurs, which side of the body experiences hemiplegia or hemiparesis?
the LEFT side
112
Which side of the brain is damaged when the patient experiences altered perception of deficits, loss of depth perception, and poor impulse control/judgment?
the RIGHT side
113
What is altered perception of deficits (R brain damage)?
overestimation of abilities
114
To what degree should the bed be elevated for a stroke?
at least 30 degrees
115
How often should ROM exercises be done after a stroke, and when should they be started?
- every 2 hours
- start early
116
Which side of the body should use passive ROM exercises after a stroke?
the AFFECTED side
117
Which side of the body should use active ROM exercises after a stroke?
the UNAFFECTED side
118
How can the nurse help with contracture after a stroke?
- give the patient a washcloth to hold
- contracture makes it hard to clean hands
119
What vital sign is important to monitor after a stroke, and when should the provider be notified?
- BP
- notify if >180/110
120
To ensure safe feeding, what should the SLP do (stroke)?
a swallow study
121
What consistency should liquids be for a patient recovering from a stroke?
thickened
- apple sauce
- cream soup
- pudding
- cooked cereal
122
What side should be dressed first after a stroke?
the AFFECTED side
123
Stroke, hypoxia, and substance withdrawal are risk factors for what?
seizures
124
Infants under what age are at risk for seizures?
< 2 y/o
125
Abrupt cessation of what kind of drug is a risk factor for seizures?
anti-epileptics
126
What metabolic disorders put someone at risk for seizures?
HYPOglycemia and HYPOnatremia
127
Exposure to what toxins are a risk factor for seizures?
carbon monoxide and lead
128
What does the prodromal phase of a seizure look like?
signs or activity that precedes a seizure
129
What does the aural phase of a seizure look like?
a sensory warning, the first few seconds of a seizure
130
What does the ictal phase of a seizure look like?
a full seizure, 1-3 minutes
131
What does the postictal phase of a seizure look like?
recovery
132
What can generalized seizures begin with?
aura
133
What is an aura (seizure)?
alterations in vision, smell, hearing, emotional feelings
134
What is a tonic seizure characterized by?
stiffening of muscles
135
What is a clonic seizure characterized by?
jerky spastic movements
136
How long does a tonic episode last during a tonic-clonic seizure? What happens after?
a few seconds and then loss of consciousness
137
How long does a clonic episode last during a tonic-clonic seizure?
1-2 minutes
138
What is a myoclonic seizure characterized by, and how long does it last?
- brief jerking and stiffening of the extremities
- lasts a few seconds
139
What characterizes an atonic/akinetic seizure, and what is it followed by?
loss of muscle tone for a few seconds followed by confusion
140
Can you put anything in a patient's mouth or use restraints during a seizure?
NO!!!
141
What position should a patient be in while having a seizure?
side lying
142
What should be protected during a seizure?
- the head
- privacy
- the body from injury
143
What needs to be documented about a seizure?
onset and duration
144
When is a seizure considered a medical emergency?
if it lasts longer than 5 mins
145
What assessments should be done after a seizure?
- injury
- neuro, PERRLA
- vitals
- trigger of seizure
146
How many antiepileptic meds should be used every day?
ONE
147
What is an adverse effect of phenytoin?
bleeding gums
148
What are some adverse effects of phenobarbital?
respiratory depression and hypotension
149
What do most meds for seizures cause at the beginning of treatment?
drowsiness
150
What do seizure precautions consist of?
- bed in the lowest position
- side rails up
- padded side rails
- suction and oxygen available
151
When does the prodromal stage of migraine with aura start?
hours to days before onset
152
How long does the aura stage of migraine with aura take to develop?
minutes to an hour
153
What symptoms occur during the aura stage of a migraine?
- numbness and tingling in the mouth, lips, face, and hands
- visual disturbances
154
When do a severe headache, N/V, drowsiness, and vertigo occur for migraine with aura?
the second stage
155
What does the headache feel like in the third stage of migraine with aura?
dull
156
What symptoms occur in the recovery phase of a migraine with aura?
muscle ache and contracture of the head/neck muscles
157
What causes a migraine without aura? How long does it last?
- pain is aggravated by physical activity
- can be caused by stress, premenstrual tension, and fluid retention
- 4-72 hours
- early in the morning
158
How long does an atypical migraine last?
longer than 72 hours
159
What does migraine pain feel like?
throbbing, unilateral
160
What does a cluster HA feel like, and how long does it last?
non-throbbing, intense, unilateral
- 30 mins to 2 hours
161
What type of environment is good for someone with a migraine?
cool, dark, quiet
162
What should a HA journal consist of?
patterns, auras, symptoms, triggers
163
How much and how long should oxygen therapy be used for cluster HA?
12 L for 15-20 mins
164
What foods trigger migraines?
foods with tyramine, MSG, high-preservatives
165
What foods trigger cluster HA?
foods with tyramine, MSG, nitrates (preservatives)
166
What medications induce migraines?
- ranitidine
- estrogen
- nitroglycerin
- nifedipine
167
What can a lack of quality rest, stress/anger/anxiety, and glare/flickering/excess light trigger?
migraines and cluster HA
168
What can environmental odors, changes in altitude, and menstrual cycle trigger?
migraine
169
What can excessive physical activity trigger?
cluster HA
170
What causes photophobia and phonophobia?
migraines
171
What causes sweating and tearing?
cluster HA
172
When are cluster HA most common?
spring and fall
173
During the spring and fall, how often does cluster HA occur?
- daily
- at about the same time everyday
- then 9-12 months of remission
174
What happens to H&H with anemia?
decreases
175
How does general anemia present?
- hypotension
- tachycardia
- cold, pale
- decreased LOC
176
Which kind of anemia is a blood transfusion done for?
general
177
What dietary deficiencies can cause iron deficiency anemia?
- vegetarian
- inadequate protein
178
Decreased absorption can cause ID anemia. How can this occur?
- gastrectomy
- diarrhea
- malabsorption syndrome
179
Increased metabolic requirements can cause ID anemia. How can this occur?
- pregnancy
- lactation
180
What are the early signs of ID anemia?
- fatigue
- SOB
- cold intolerance
181
What are the late signs of ID anemia?
- brittle, spoon-shaped nails
- cheilosis
- glossitis
- pica
182
What is cheilosis (ID anemia)?
cracks at the corners of the mouth
183
What is glossitis (ID anemia)?
smooth, sore tongue
184
What is pica (ID anemia)?
eating things that are not food
185
What does total iron-binding capacity measure (ID anemia)?
serum transferrin
186
What does serum ferritin indicate (ID anemia)?
the body's total iron stores
187
What does serum iron measure (ID anemia)?
the amount of iron in the blood
188
What diagnostic results indicate ID anemia?
- decreased serum iron
- increased TIBC
189
What foods should someone with ID anemia eat, and how many meals?
- soft, cool, bland foods
- increased protein and vitamins
- 4-6 small meals
190
What type of anemia are ferrous sulfate, ferrous fumarate, and ferrous gluconate used for?
iron deficiency
191
What does vitamin C do to iron absorption and what can it not be given with?
- increases absorption
- no milk
192
What foods contain heme iron?
- beef
- chicken
- clams
- egg yolks
- turkey
- pork loin
- veal
193
What foods contain nonheme iron?
- bran flakes
- brown rice
- whole grain bread
- dried beans and fruit
- greens
- oatmeal
194
What causes pernicious anemia?
inadequate B12 (vegetarian), lack of intrinsic factor
195
How does pernicious anemia present?
- jaundice
- smooth/sore/beefy red tongue
- diarrhea
- problems with proprioception and balance
- weakness
196
What is a progressive symptom of pernicious anemia?
paresthesias
197
What does the Schilling test do (pernicious anemia)?
measures vitamin B12 absorption
198
What is cyanocobalamin used for?
B12 supplement for pernicious anemia
199
How would cyanocobalamin be given if B12 deficiency was due to dietary intake?
orally
200
How would cyanocobalamin be given if B12 deficiency is due to a lack of intrinsic factor, malabsorption, or bowel removal?
parenterally or intranasally
201
What foods have increased amounts of B12 (pernicious anemia)?
- meat
- eggs
- dairy
- liver
- shrimp
- cheese
202
What are the clinical manifestations of thrombocytopenia?
- petechiae
- ecchymosis
- bleeding gums
- nose bleeds
- blood in stools/urine/vomit
203
What is the neutropenic ANC level associated with thrombocytopenia?
<1,000
204
At what PLT level is there the greatest risk for bleeding?
<50,000
205
At what PLT level might spontaneous bleeding occur?
<20,000
206
When should PLT be administered?
<10,000
207
What bleeding precautions should be taken for thrombocytopenia?
- avoid IVs/injections
- apply pressure 10 mins after blood draws
- use an electric razor
- use a soft-bristled toothbrush
- avoid blowing the nose vigorously
- make sure dentures fit
- avoid restrictive clothing
- NO crossing legs
208
What do WBCs invade and destroy in leukemia?
bone marrow, where PLT and H&H are made (so they will decrease)
209
What should be monitored with filgrastim (leukemia)?
bone pain
210
What lab levels are decreased with leukemia?
H&H and PLT
211
What precautions should be used for leukemia?
neutropenic precautions
212
Chemotherapy causes immunosuppression and neutropenia. What should be monitored?
- temp (report >100)
- WBC
- ANC (<1000 = weak immune system)
213
Chemotherapy can cause N/V and anorexia. What should you assess for?
- dehydration
- fluid and electrolyte imbalances
214
What medication should you give before chemotherapy to prevent N/V?
ondansetron
215
How should you eat when going through chemotherapy?
- low fat
- high-calorie, protein, and nutrient-dense foods
- cold foods that do not need cooking
- dry foods (crackers, toast)
- no salty, acidic, or spicy foods
- bland, soft foods
- several small meals a day
- no liquids with meals
216
When should you select a hairpiece for chemotherapy?
before starting tx
217
When does hair loss begin after starting chemo?
7-10 days
218
What is mucositis, and when does it occur?
- during chemotherapy
- inflamed mucous lining of the upper GI tract (mouth to stomach)
219
What is stomatitis, and when does it occur?
- during chemotherapy
- inflamed tissues of the oral cavity (gums, tongue, roof/floor of mouth, inside lips/cheeks)
220
What types of mouthwash should you avoid during chemotherapy?
glycerin-based or with alcohol
221
What medications should be avoided with chemotherapy?
NSAIDS
222
During chemotherapy, what can cause loss of sensation, ortho hypo, loss of taste, and constipation?
peripheral neuropathy
223
What 3 things can radiation cause?
- skin changes
- hair loss
- debilitating fatigue
224
Where is internal radiation therapy placed?
in body orifice or cavity
225
What becomes radioactive with internal radiation?
waste products
226
What does a dosimeter film badge do during internal radiation?
records personal radiation exposure
227
How long can visitors stay, and where can they stand in the room of someone receiving internal radiation? Who cannot visit?
- 30 mins, 6 feet away
- no pregnant women or anyone under 18
228
How is external radiation therapy done?
teletherapy, small doses over several weeks
229
What skin injuries are associated with external radiation?
- blanching
- erythema
- desquamation (skin peeling)
- sloughing
- hemorrhage
230
What mouth injuries are associated with external radiation?
mucositis and dry mouth
231
What neck injuries are associated with external radiation?
difficulty swallowing
232
What abdominal injuries are associated with external radiation?
gastroenteritis
233
External radiation can cause dysgeusia, which affects taste. What food is unpalatable?
red meat
234
How should you wash the skin during external radiation?
with mild soap and water using a patting motion
235
What should you NOT remove/wash off from radiation?
radiation tattoos and markings
236
What do interleukins do during immunotherapy?
help coordinate inflammatory and immune response
237
What should you watch for with interleukins?
flu-like symptoms and edema
238
What do interferons do during immunotherapy?
exert exert an antitumor effect
239
What should you watch for with interferons?
lethargy and ortho hypo
240
What is the ABCDE evaluation for skin cancer?
A: asymmetry
B: borders
C: color
D: diameter
E: evolving
241
Breast changes, pain, and soreness are manifestations of what type of cancer?
breast
242
How many servings of veggies should someone with breast cancer eat a day?
at least 5
243
How often should you do a self-breast exam?
monthly
244
How often should a clinical breast exam be done?
- every 3 years for 20-39 y/o
- yearly for 40+ y/o
245
What cancer is a thoracentesis done for?
lung cancer
246
Where does the scope go when bronchoscopy is done for lung cancer?
through the trachea
247
What are the clinical manifestations of prostate cancer?
enlarged/hard prostate and urinary symptoms
248
What confirms prostate cancer after a digital rectal exam or prostate-specific antigen test?
biopsy
249
Changes in stool consistency/shape and the presence of blood in the stool are manifestations of what type of cancer?
colorectal
250
How often should a colonoscopy be done to screen for colorectal cancer?
every 10 years
251
How often should a sigmoidoscopy be done to screen for colorectal cancer?
every 5 years for ages 50-75
252
How often should a fecal occult blood test be done to screen for colorectal cancer?
annually for ages 50-75
253
What tests determine cervical cancer?
PAP test followed by a biopsy
254
How often should HPV screening be done?
every 5 years for women 30-65 y/o
255
What are the vaginal manifestations of cervical cancer?
bleeding between menses and water/blood-tinged discharge
256
What are the urinary manifestations of cervical cancer?
dysuria and hematura
257
What cancers are being childless, having your first child after 30, HRT, early menarche, and late menopause risk factors for?
breast and ovarian
258
What can protect against ovarian cancer?
birth control and pregnancy
259
What abdominal symptoms are present with ovarian cancer?
- pain/swelling/discomfort
- dyspepsia
- gas
- distention
260
What happens to the mouth with oropharyngeal cancer?
- lesions
- red patches
- bleeding
- difficulty chewing/swallowing
261
How can you tell if oropharyngeal cancer is present by doing to Toluidine Blue 1% staining test?
malignant cells stain blue
262
Chemotherapy can cause N/V and anorexia. What should you assess for?
- dehydration
- fluid and electrolyte imbalances
