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NUR 120 > Unit 1 > Flashcards

Unit 1 Flashcards

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1
Q

What are 6 age related changes to the eye? Explain.

A

Visual acuity-(snellen) lens, presbyopia (reading glasses)
Ocular structures-dec elasticity, en/entropion, lacrimal (dry eye)
Ocular fundus-mac degen
Cataract-lens
Glaucoma-dec IOP
Mac degenerate-drusen, central vision loss

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2
Q

What are 4 diagnostic studies related to problems of the eye?

A

Ophthalmoscopy-inner eye (direct, indirect)
Tonometry-IOP (screen for glaucoma)
Slit lamp-magnification inner eye
Refraction/accommodation-eye shape and lens focus

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3
Q

What are 5 common eye disorder categories that occur across the lifespan?

A 
Disorders of cornea
Disorders of lens
Disorders of aqueous humor circulation
Disorders of posterior chamber
Ocular emergencies
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4
Q

More specifically, define disorder of the cornea.

A

Corneal Abrasions:
Commonly scratching, overuse of contacts, and foreign bodies.

Symptoms: pain, tearing, photophobia.

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5
Q

More specifically, define disorder of the lens.

A

Cataracts:
Nuclear-genetic, assoc. w/ myopia (nearsightedness)
Cortical-(lens)vision worse in light (sunlight exposure)
Posterior subscapsular- (front of post. Capsule) assoc. w/ Diab, trauma, light sensa, diminish near sight
Post OP- no Asa, lifting, use meds/patch/sunglasses.
Risks pg 1858

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6
Q

What are conservative and invasive tx’s for cataract?

A 
Medical:
Change glasses
Antioxidants
Magnify glasses
Mydiatics (pupil dilator): atropine, scopalamine
Surgical:
INTRA/extra capsular cataract extraction
Phagoemulsification
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7
Q

More specifically, define disorders of aqueous humor circulation.

A

Glaucoma: Tx same for both:
Open-most common, trabecular obstruction, asymptomatic, bilateral.
Closed-pupillary block, rapid progression, iris shift forward

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8
Q

What are the pharm tx for glaucoma?

A

Miotics(Coliner, eye constric)-pilocarpine and Timolol
Indirect anticholinesterase Inhib-esopto eserine,humorsol
Beta block-(dec aqueous humor produc) timoptic (Timolol), betagen(levobunolol)
Carbonic anhydrous inhib-(dec aque humor prod)-acetazolamide(diamox)
Osmotic diuretics-dec plasma vol. glycerol, mannitol

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9
Q

What are the 4 disorders of the posterior chamber?

A

Retinal detachment
Mac. Degen.
CMV retinitis
Retinitis pigmentosa

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10
Q

What are tx for retinal detachment?

A

Sclera buckle
Laser photo coagulation
Cryotherapy

Vitrectomy

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11
Q

What occurs in macular degeneration?

A

2 types:central vision deficit, retain periph, no cures.

Dry-outer layers break down causing drusen (yellow spots beneath retina)
Wet-proliferation of abnormal blood vessels growing under retina.

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12
Q

What occurs with cytomegalovirus (CMV) retinitis?

A

Common in AIDS
Related to herpes
Tx w/ antivirals

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13
Q

What occurs in retinitis pigmentosa?

A

Genetic disorder
Initial manifestation
No cure/tx

(Black periph)

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14
Q

Lastly, what are the ocular emergencies?

A

Trauma
Foreign bodies
Chem burns-irrigate!

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15
Q

What factors are important to assess pre operative?

A 
Health hx
Baseline 
V/s
Nutrition
Culture/rel.
Dentition
Drugs/alcohol/smoking use
Medications (notify anesth w/ antisz and BP)
Dz's/disabilities
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16
Q

What are some necessary assessments in PACU?

A

Resp-hypo pharyngeal obstruction, sleep apnea./resp. Rate/depth, o2 sat, breath sounds
Cardiovas.-hypoten, shock, hemor, HTN/dys.
Neuro-pain, N/v, loc, body temp
Dressing, IV site, tubes, elimination, positioning, then
H to T assess AP/Lat.
Aldrete score.

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17
Q

What are some complications to be aware of post op?

A 
Shock-Inc. HR, dec BP
Hemor.
DVT-clot
Pulm emb-at risk: female on BC, smokers, h/o clots
Resp comps-change in sounds
Urinary reten
Gastrointen
Wound
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18
Q

Before advancing to outpt extended care or unit from PACU, surgical patients should:

A

Awake, oriented, alert, easily aroused by verbal stimuli.
Patent airway, maintain blood o2 92% room air.
Active airway protective reflex.
Hemo dynamically stable w/ acceptable v/s for 15-30min.
No active bleeding.
Controlled pain.
Free from vomiting.

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19
Q

What is bone, purpose, and two types?

A

Connective tissue
Ground substance contains calcium salts (makes bone rigid)
Blocks o2 and nutrient diffusion (periosteum, haversion/volkmanns canals)
Cancellous-sponge like
Compact-cortical layered

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20
Q

What are 4 types of bone cells?

A

Osteoprogenitor cells-undifferentiated.
Osteoblasts-bone building (ossification/calcification(alkaline phosphatase)=healing)
Osteocytes-mature (derived from blasts)
Osteoclasts-bone resorption (bone chewing)

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21
Q

What is required for bone maintenance?

A 
Weight bearing activity
Absorption of 1000-1200mg calcium daily
Blood supply
Hormonal contro (PTH, Calcitonin) vitamins (Calcium, Vit D)
Bone remodeling
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22
Q

What happens if bone Mait isn’t functional?

A

Osteopenic (weak bones) low bone mass

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23
Q

What hormone regulates calcium and phosphate levels in the blood? How? What stimulates this hormone? What does this hormone stimulate?

A

PTH
Prevents serum calcium levels from falling and phosphate from rising above normal. (Bone resorption, conserving at the kidney, intestinal absorption, and reducing phosphate)
Decreasing CA
Vit D activation by kidney

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24
Q

What hormone is released by the thyroid gland when blood calcium is too high? What does it inhibit?

A

Calcitonin
Osteoclasts (prevents ca from leaving bone)
Vit D activation and Calcium resorption by kidneys

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25
What is Vit D needed for? What are the two sources and By what two ways is it activated? Explain.
Absorb dietary calcium. Intestinal absorp-jejunum (fish, liver, milk) Skin production-ultraviolet radiation from sunlight Then Liver to kidney
26
What are 4 other hormones related to bone maintenance?
TH-increased level will increase bone resorption GH-Increases bone remodeling Estrogen-stims osteoblasts, inhibs osteoclasts (resorption) Testosterone-inc skeletal growth/bone mass, converts to estrogen
27
What are the 2 types of bone marrow and what bones are they located?
Yellow-long bones shaft Red (hematopoiesis) -spongy, flat bones, medullary of long bone (sternum, illeum, vertebrae, rib) Wbc/RBC productions
28
Diff flaccid vs spastic.
Muscles are always in a state of readiness called tone. W/O tone=flaccid (atone) Inc tone=spastic (hypertonic)
29
What would you assess for in musculoskeletal system?
Pain-Types, describe, started, relief, worse, rate, radiate. Edema Sensation (numbness/tingling)-compare to unaff ext., neurovascular Color/temp/cap refill Pulse (and distal to affected area) Crepitus Spasms/stiffness-ROM Appearance-deformities, alignment, shortening Health hx-past, nutrition, lifestyle, comfort, meds, genetics, surg/tx's Posture/gait-kyphosis (resorption), lordosis, scoliosis
30
Diff the types of pains.
Bone-deep dull (not usual w/ movement) Muscle-sore ache Fracture-sharp piercing (relief by immobility) Joint-worse w/ movement Effusion-excessive fluid in capsule
31
What are the tests of sensation and movement of peripheral nerve function? Name the nerves.
1st Sensation. 2nd Movement. Peroneal: prick between great and second toe. Dorsiflex and extend toes (damage can have foot drop) TIbial: prick medial and lateral surface of sole. Plantar flex toes and foot. Radial: prick between thumb and second finger. Stretch out thumb, then wrist, then fingers at metacarpal joint Ulnar:prick distal fat pad of small finger Abduct all fingers Medial:prick top or distal surface of index finger Touch thumb to little finger, flex wrist
32
What are the 5 P's of circulatory checks?
``` Pain Paresthesia Paralysis Pulse Pallor *also temp ```
33
What CBC labs are important in musculoskeletal function w/ values?
``` Hemoglobin: Male 13-18 g/DL Female 12-16 Hematocrit: Male 42%-52% Female 35-47 WBC adult 4500-10000 WBC w/ diff: % of the total number of RBC's ```
34
What are the coagulation studies and values?
(Oral anticoagulant)PT (prothrombin time) 9.5-12 seconds (Heparin)PTT (partial thromboplastin time) 20-39 seconds INR (international normalized ratio) 1.0 (related to PT)
35
What are the three serums for blood chemistry?
Serum Calcium: Most abundant cation Elevated CA = metastatic bone dz, prolonged immobility, mult. Fx's Decreases CA=low albumin (malnutrition), chronic renal failure (phosphorus retention) Serum Osteocalcin: Biochem marker of bone metabolism Serum Phosphorus: Intracellular anion, 80% combined w/ calcium Inverse to calcium (while one is high other is low, visa versa) controlled by PTH, ca, renal excretion, intes absorp. Inc level=bone tumor, healing fx, renal failure, hypoparathyroidism, hypo calcemia. Dec level=hyperparathyroidism, osteomalacia, malnutrition.
36
What enzymes are monitored to detect problems?
``` Bone enzyme: alkaline phosphatase (ALP)-inc = bone build up occurring (osteoblasts) for Cancer, metastatic. Muscle enzyme: Aldolase (ALD) serum Creatine phosphokinase (CPK/CK) Both: skeletal muscle damage=inc level. ```
37
What are the blood tests for Rheumatic d/o's?
Rheumatoid Factor (RF)-determines presence of abnormal antibodies (attacks joints)-pos w/ presence of RA LE Prep/Antinuclear antibody (ANA)-measures antibodies that react w/ a variety of nuclear antigens (destroying nucleus of self) Erythrocyte sedimentation rate (ESR)-measures the rate at which RBC's settle out of unclotted blood in 1 hour (15-30mm/h) C-relative protein (CRP)-shows presence of glycoproteins due to inflam process
38
What other 2 lab studies can be done for musculoskeletal not concerning blood?
24 HR urine collection-for calcium elevation (in osteolytic d/o) Synovial fluid analysis-arthrocentesis (joint aspiration) for RA, complements, WBC, and glucose.
39
What are 3 types of immobilization devices?
Cast (splint and brace) External//internal fixation Traction
40
What are two types of cast materials and diff them.
Plaster-give off more heat, dries 24-72 hrs, handle with palms, and rest on pillow Fiberglass-lighter, stronger, water resist., sets in 5 min., more common Can apply ice as ordered, do ROM exercises, check NV status (blue-dec venous return, pale/cold-arterial obstruction), six P's, be aware of pressure areas (bony prom)
41
What are 3 complications associated with casts?
Compartment syndrome-increased pressure from cast and muscle compart, compromises blood flow, then low tissue perfusion leading to poss. Ischemia and neuromuscular damage w/I hrs. S/s:pallor, cool, poor cap refill, paresthesia, unrelieved pain also w/ passive rom. LOWER TO LEVEL OF HEART, AND CALL PROVIDER WHICH MAY REMOVE OR BIVALVE Disuse syndrome-muscle atrophy leading to deteriorated body systems. HAVE PT CONTRACT ISOMETRIC hourly. Skin breakdown-hot spots, tissue necrosis possible, window cut
42
What are the 2 forms of traction?
Skin-indirect, applied to skin prior to surg. Ext:4.5lbs-8lbs Pelvis:10-20lbs Skeletal-direct, applied to bone w/ pins drilled thru skin, pulley/rope Contin-15-25lbs *mon. Nv status/lung and bowel sounds q4hrs, weights rem per md order, shift weight q1hr, rom 3-4qday, pin site asses q8hr/care 1-2qday
43
What are 5 types of skin traction?
``` Bucks-mostly hips Russell's-tibial plateau fx, heel off bed, better rotation control, small motion of knee/hip Bryants-femur fx (children 2 and under) Dunlops-upper extremity Pelvic-muscle spasm/fx's in low back ```
44
What is to be expected with a patient on a fixation?
``` Sutures and drain V/s, o2, Nv checks q2-4hrs Incentive spirometer Turn, cough, deep breathe Positioning Rom 3-4 times day Amb on 2nd day Mon labs, compare to preop Aseptic pin care Notify if pins/clamps loose ```
45
What are complications of immobility?
``` Ileus Constipation Anorexia Pneumonia Renal calculi UTI DVT ```
46
What is the process of bone healing s/p fx? | What influences this rate? (10-18weeks)
1.Fx hematoma (torn vessel in periosteum) Inflammation/revascularization Reparative phase (granulation tissue) Ossification of callus (osteoblasts and mineralization) Remodeling (resorption) 2. Fx type Blood supply Surface contact of fragments (casts, etc) General health
47
What are the s/s of fx?
``` Pain Loss of function, rom Deformity -edema and ecchymosis -shortened limb and rotation -discoloration -crepitus ```
48
What is the emergency management of a fx? | Then clinical management.
``` Immobilize injury area including joints proximal and distal. Apply splint Assess nv stats prior and post splinting (compare to other ext) Open fx-cover w/ sterile dressing 2.asses (inspect/palpate) Diag text (X-rays) Apply ice as ordered, rest, above heart RICE! ```
49
What are complications of fx's?
Infection-higher risk w/ open Shock (hypovolemia-hemorrhage) Fat embolism 24-72 hrs post surg. (long bones, mult fx's, crush)-sob, hypoxia, confus, tachycardia/Pnea, chest pain, pallor, petechiae (nip to face), personality changes (call MD, VENT, O2, ICU) Compartment syndrome-fasciotomy procedure, swollen hard DVT-lack of muscle contract/bed rest, warmth red pain edema DIC-coag factors used up making massive bleed Delayed Union/non Union-caused by infection, poor diet, not listen Renal stones (serum ca inc.)-inc serum cal
50
Define contusions strains and sprains.
Contusion-soft tissue Strain-pulled muscle, overuse, excessive stress Sprain-injury to ligaments surrounding joints Tx: RICE
51
What are the two areas of hip fx? Explain the diff.
Intracapsular-neck break-dec. blood flow leads to avascular necrosis, bone ischemia. Extra capsular-better healing, risk for splintering (communiated)
52
What are s/s for hip fx?
``` Deformity:shortened, addicted, externally rotated Crepitus (bone to bone) Pain (hip, groin, medial) Immobility Muscle spasm Edema Ecchymosis/bleeding ```
53
What are some medical managements for hip fx's?
Bucks extension Surgical tx: open/closed reduction and internal fixation Hemiarthroplasty (bone grow around, half joint replaced) Closed reduction w/ per cutaneous stabilization THR
54
What are some potential complications with hip fx?
``` Hemorrhage Peripheral neurovascular dysfunction DVT Pulmonary comps Pressure ulcers ```
55
What are nursing interventions s/p hip surg?
Avoid hip dislocation. - keep leg abducted, wedge/pillows, turn pt to unaffected side - do not flex hip more than 90 deg. - HOB 60 deg or less - avoid internal rotation - avoid crossing legs - assess for dislocation, notify md asap if suspected - hip pre caut. 4 months
56
What are the typical wound drainages s/p THR?
Portable suction device: drains fluid/blood - 200-500ml in 1st 24hrs - active bleeding indicated if more than 250ml in first 8hrs (and bright red) - 30ml drainage over 8hrs by 48 hrs p/o - auto transfusion drainage system (blood to be used w/I 6 hrs of collection)
57
What are the s/p knee replacement nursing interventions?
``` Compression bandage Ice Nv status checks Promote active flexion of foot Drain care (hemovac), wound care No pillows under knee Positioning, CPM device Pain management Ambulation same day Prevent comps:thromboemb., peroneal nerve palsy, infection, LROM ```
58
What are the possible etiologies of RA?
``` Viral Bacterial Immune response of antibodies (attacks joints) Predisposition *originates in synovial tissue ```
59
What is the patho of RA? 4 steps
Synovitis:edema and congestion thicken tissue Pannus formation:granulation tissue (causing pain) Fibrous ankylosis:fusion Boney ankylosis:calcification
60
RA can be manifested in what ways?
Onset can be acute or chronic (insidious) w/ course marked by periods of remission and exacerbation. Progressive:Deforms-swan neck, ulnar drift, contractures, nodules(SubQ) S/s:Bilateral/symmetric Joint stiffness/pain and fatigue LROM Systemic-enlarged spleen, lymph nodes, weakness, depression, sjogrens syn (dry eye/mucous mems)
61
What diagnostics are useful in RA determination?
``` Clinical manis Labs: RF (pos) ESR, CRP (sig elevated in acute phases) Complement c3, c4 (decreased) CBC ANA (pos) Arthrocentesis (milky, yellow, w/leukocytes/complement) X-ray (bony erosion, narrow joint spaces) ```
62
What are pharm management for RA?
Salicylates: (asp) NSAIDS: (Ibprofen, naproxen, indomethacin) DMARDS:Methotrexate, adalinmumab, hydrochloroquine Corticosteroids: prednisone
63
What are clinical managements for progressive erosive RA?
surgery: for uncontrolled pain Synovectomy:removes synovial membrane Arthroplasty:replacement Arthrodesis:fusion Low dose corticosteroid therapy Intra articular cortico injections
64
What are the 3 types of SLE (systemic lupus erythmatosus)? | Autoimmune dz, chronic inflammatory
Discoid-skin/face Drug induced-may effect brain/kidney Systemic lupus erythematosus (lupus)
65
What is the patho for lupus (SLE)?
Dec T lymphocytes Syn of immunoglobulins and auto antibodies Immune complex formation Tissue damage (all)
66
What are s/s of lupus?
``` Skin rash (may be provoked w/ sun exposure) Joint pain sim to RA Fatigue Mouth and throat ulcers Hair loss Fever ```
67
What are the diagnostics and tx's for lupus?
No single test: Clin manis, h/p, ANA blood test No cure
68
What differs osteoarthritis from RA
``` Common Still chronic NON inflam NON systemic (Joints lose cartilage, mostly WB joints) ```
69
What is the patho for osteoarthritis (DJD)?
Articular cart thins, breaks down damaging underlying bone stim growth, forming osteophytes (bone spurs) on articular surface.
70
What are the OA Clin manis?
Joint pain/stiffness Bony enlargements: Heberdens nodes DIP (distal interphalangeal joint) Bouchards Nodes PIP (proximal interphalangeal joint) Crepitus Effusion
71
What pharms/surgical tx's can be useful in OA?
``` Analgesics-acetaminophen Cox 2 inhib-celecoxib Muscle relaxants-cyclobenzaprine Steroids:infra articular injection Opiates Osteotomy:altars weight distribution in joint Arthroplasty:replacement Debridement: bone spurs Arthrodesis:fusion ```
72
What is gout? What can increase occurrence?
Inflam D/o which purine metabolism is altered, UA is deposited and accumulates in and around joints.(tophi-mono sodium rate crystals deposits in joints). Hyperuricemia:over production urate or dec renal excretion of urate Inc ETOH intake, obesity, excessive weight gain
73
What are gouts diagnostic findings?
``` Clin symps Serum UA levels (norm 1-6) WBC and ESR 24 HR urine UA level X-ray Synovial fluid aspiration ```
74
What is osteoporosis?
Reduction of total bone mass, increased fragility, susceptible to fx. Resorption is greater than bone mass formation.
75
What meds are useful in osteoporosis?
``` Calcium/Vit d supps Alendronate Calcitonin/teriparitide Raloxifene Estrogen replacement therapy ```
76
What is osteomylelitis?
Bone infection
77
What are the post op interventions for amputation?
``` Mon for Hemorrhage Pos to prevent contracture: 1 24hrs elevate stump at intervals w/o pillow (elevate bed) Turn q 2hrs Legs together Pain man (phantom) Skin integ. Aseptic Rom trapeze Nutrition ```

NUR 120 (6 decks)

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