Final Review

PN 141 November/December 2014Rebecca Maier , RN

Vision is achieved by?

Normal vision is determined by the Snellen test

Normal vision is 20/20 Meaning you . Should be able to see . And read Line 8 at 20 feet Types of visual disorders include?

Vision Impairment

What does blind mean? AHN -Pg 607What are the nursing implications in writing the care plan?Is there more than 1 kind of blindness?Are there degrees of blindness?Are there ways of enhancing a blind person’s life?What community resources should the nurse make the blind person aware of?

For the newly blind patient

• What patient teaching needs to happen?• What community resources should the

patient and their family be aware of?

Cataracts

AHN 617-618• causes, • Signs and symptoms• treatments• teaching

Diabetic retinopathy

• Causes, • treatments,– Cryotherapy– Photocoagulation

• nursing implications

Glaucoma

• Signs and symptoms• Treatments– Rx – include rationale– surgery

Infectious diseases of the eye

• What do they look like • What are the nursing implications• What is the nurse’s number one goal

Noninfectious eye conditions

• Sjogren syndrome – S/S (signs and symptoms)– Causes – Dx– Tx

• Ectotropion

Loss of the eye

Actual loss of the eye even if due to severely painful blindness is still a traumatic event for the patient.You must be cognizant of their need to grieve.Post operatively you need to apply pressure dressings to the socket to control bleeding.

The Ear• Parts of the ear

• How does hearing work?

Hearing loss

• Causes– Structural• Missing part• Broken part

– Environmental• Noise• Chemicals

– Medical • Medication – ototoxic

Common Issues

• Acute otitis media• External otitis– Manifestations – what will the pat report?

• Otitis media– Occurs most frequently in children (why?)– Tx - Rx

• Labyrinthitis • Obstruction

Meniere’s Disease

• Etiology/pathophysiology– Chronic disease of the inner ear– Recurrent episodes of vertigo unilateral

progressive nerve deafness, and tinnitus– Increase in endolymph fluid( increased pressure in

the inner ear)– The cause is unknown– Attack triggers: alcohol, nicotine, stress, and certain

stimuli such as bright lights and sudden movements of the head

Meniere’s Disease• Medical management

• No specific treatment

• Decrease fluid pressure– Fluid restriction; diuretics; low-salt diet

• Avoid caffeine and nicotine

• Dramamine, meclizine, and Benadryl – use between attacks

• Meds may be given IV during acute attacks

What is a Incusectomy?

What is a stapedectomy?

What are the nursing implications of a Stapedectomy?

• Pt positioning• How is the pt going to feel when he first

recovers post op?• What post op teaching does the nurse need

to give?• What does the nurse need to be sure to tell

the pt. about their hearing to relieve any anxiety?

What is a Tympanectomy?

Tympanoplasty is used to do what?

perforated ear drums, . otosclerosis, or for dislocation necrosis of the small bones of the inner ear. These are all involved in conductive hearing loss – Why?

The Brain

• What are the parts and • what do they do?

Cognitive Assessment

Mental status assessment• Orientation• Mood and behavior• General knowledge (AKA – Fund of

knowledge)• Short and long term memory

What is the Reticular Activating System?

The reticular activating system (RAS) is a part of the brain located in the brain stem. In human biology, it is believed to play a role in many important functions, including sleep and waking, concentration, focus, behavioral motivation - introspection, breathing, and the beating of the heart. Trauma to this area can cause a coma, and it has been linked to several different medical conditions, including narcolepsy. The reticular activating system is located in the brain stem.

Head trauma

Nursing interventions – what are they?

Rhinorrhea – could be blood or serosanguineousGently wipe do not clean orifice

Intracranial pressure• What are the s/s of increased intracranial

pressure? AHN 668 - 672

What is the appropriate nursing intervention to help reduce ICP?

• Elevate the head of the bed to 30 -45 degrees to promote venous return

• Place the neck in a neutral position (not flexed or extended to promote venous drainage

• Position the pt. to avoid flexion of the hips, the waist, and the neck and prevent any rotation of the head, especially to the right. Extreme flexion of the hip causes increased intra-abdominal and intra-thoracic pressure which can increase ICP.

What is the cardinal sign of increased intracranial pressure?

Changes in LOCPt will become increasingly lethargic and difficult to arouse.

Migraine headaches

What causes them?How do they present – what will the nurse see or might the patient report?What does prodromal mean?How are they treated?What are the nursing implications?

Medications for migraine

• Eletriptan– All triptan Rx are serotonin receptor agonists

• Almotriptan• Rizatriptan • Ergotamine

– Ergotamines may be used to stop or treat symptoms of an emerging migraine.

– Ergotamines narrow (constrict) blood vessels in the brain. It is not clear how they work to stop a migraine.

– may not be as effective as other migraine medicines, such as triptans.

Craniocerebral Injury

• Is Another name for? (Head trauma- concusion)

• Nursing implications?

What is a herniated disk?

What is a myelogram?

Myelography (Myelogram) is a diagnostic examination of the spine. A special x-ray sensitive contrast dye is injected to illuminate the spine, allowing identification of problems within the spine, spinal cord and nerve roots.http://www.nebraskamed.com/health-library/3d-medical-atlas/174/myelography

What are the nursing implications of a myelogram?

• Pt teaching• Pre procedure questions• Post procedure teaching- reinforcement

Spinal cord injuries

• Signs and symptoms• Nursing implications– Emergent situations• Autonomic dysreflexia / hyperreflexia

– Signs and symptoms

• Areflexia/spinal shock

• Diagnostics • Management

Surgery practice question

10. What are surgical navigational systems?a. Computerized devices that guide the surgeonb. A set of detailed anatomic maps pinpointing specific areas of the brainc. A written set of progressive processes for the resection of small brain tumorsd. The use of radioactive materials to pinpoint small tumors of the brain

What are surgical navigational systems?

Brain Surgery NavigationVideo URL: http://www.youtube.com/watch?v=jYCiKOERYD8

Surgical navigational systems are computerized devices that guide the surgeon and make possible the resection of tumors that were once thought to be in operable.

Degenerative Disorders

• The most common are?– Alzheimer’s– Parkinson’s– Multiple Sclerosis– ALS– Organic brain pathology/syndrome (AKA –

disturbed sensory and perceptual function)• Their signs and symptoms are?• Treatment is

Other neurological issues

SeizuresCauses:

Unknown / idiopathicCausesNursing considerationsFamily and patient teaching

EpilepsyCausesNursing considerationsFamily and patient teaching – what to expect

Other neurological issues

• Encephalitis– Dx– Tx

• Meningitis– Dx– Tx– Ns. Implications

• Guillain-Barre Syndrome– Dx and implications

Nursing implications

• When interviewing a patient about their neurological symptoms the nurse should use what kind of communication?