What does SBAR stand for?
Situation, Background, Assessment, Recommendation
Stroke risk factors
Age, gender, ethnicity or race (blacks at a higher risk), family history and heredity, HTN, heart disease, DM, elevated cholesterol, smoking, excess alcohol, metabolic syndrome
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What does SBAR stand for?
Situation, Background, Assessment, Recommendation
Stroke risk factors
Age, gender, ethnicity or race (blacks at a higher risk), family history and heredity, HTN, heart disease, DM, elevated cholesterol, smoking, excess alcohol, metabolic syndrome
Weber test normal vs abnormal
Normal: hearing sounds equally bilaterally; abnormal: only hearing sounds on one side
Signs and symptoms of retinal detachment
Flashes of light, floaters, a “cobweb” or “hairnet” or ring in the field of vision. Gradual loss of peripheral or central vision “like a curtain” coming across the field of vision. No pain.
PE tubes: why we use them, what do we do if they want to be in the water, infection drainage
Used for better hearing (relieve fluid buildup). Wear earplugs for swimming, or being in water. If there is an infection it will drain, but if there is purulent draining or a fever, notify HCP
Child eye surgery: decrease IOP, room safety
Parents can be with pts in pre and post op, not OR, for child’s comfort. Try to not let them cry, as it will increase IOP. Remove any safety hazards from room and area so they do not hurt themselves
Snellen chart
Viewed from 20 feet away. 20/40 is you are seeing at 20 feet what someone with 20/20 sees at 40 feet
Cataracts signs and symptoms
Gradual decrease in vision. Abnormal color perception. Increased glare, especially at night. Blurry vision.
Cataract post op precautions
Avoid activities that increase IOP, including bending, stooping, coughing and lifting. Pay attention to head positioning, pt should be in a Semi-Fowler’s position. Proper eye care and hygiene techniques. S&S of infection: increased or purulent drainage, increased redness, decrease in visual acuity. How to properly instill eye medication, how to take pain medication and report pain not relieved by medication. Importance of continued follow up. Measures to cope with vision loss such as large screens, audiobooks, additional lighting and promote safety
Beta-blocker eye drops contraindicated in the patient with..
bradycardia, second- or third-degree heart block, cardiogenic shock, and heart failure. chronic obstructive pulmonary disease (COPD) or asthma.
Glaucoma medications purpose
Decrease pupil size (miosis), increase outflow of aqueous humor, decrease IOP. Does not change the volume of vitreous humor
Communication technique for seigneurial hearing loss pts
Nonverbal aids: draw attention with hand movements, have your face in good light when speaking to pt, maintain eye contact, use a face shield or clear face mask if mask is needed, avoid chewing, eating, or smoking while talking, remove background noise, and move closer to the pt’s better ear. Verbal aids: speak normally and slowly, do not shout, do not exaggerate facial expressions, do not overenunciate, use simple sentences, rephrase sentence using different words, write name or difficult words, speak in a normal voice directly into good ear
Age related macular degeneration assistive devices
Sunglasses, extra lighting, daytime driving, assistive devices to read such as larger print, magnifying glass
Furosemide and tinnitus
Furosemide has the potential to cause tinnitus and hearing loss.
Parkinson’s eating and assistive devices
Patients who have dysphagia and bradykinesia need appetizing foods that are easy to chew and swallow. The diet should have adequate fiber to reduce constipation. Cut food into small bite- size pieces; gyroscope utensils
MS infection risks
Incontinence and UTIs are very common. Death usually occurs from infection (pneumonia) related to immobility
ALS nursing interventions
Support the patient and caregivers emotionally. This includes grieving related to the loss of motor function and impending death. Discuss advance directives and artificial ventilation with the patient and caregiver. Provide the caregiver with support and resources to combat the fatigue and stressors they experience.
Huntington’s disease genetics
It is a genetically transmitted autosomal dominant disorder. There is a 50% chance a child will develop if one parent has it
MS medication therapy evaluation
Medication is effective when symptoms improve
Myasthenia gravis medication importance of schedule
Inadequate dosing can cause myasthenic crisis. Excessive dosing will cause a cholinergic crisis, which occurs due to too much cholinesterase inhibition. Cholinergic crisis symptoms are very similar to myasthenic crisis. Features of a cholinergic crisis include involuntary muscle contraction, extreme weakness, flaccid muscle paralysis, sweating, excessive salivation, diarrhea, and constricted pupils
RLS interventions
Lifestyle changes; decrease use of caffeine, alcohol or tobacco; maintain regular sleep habits; daily mild to moderate exercise, relaxation techniques, and massaging and stretching the legs may help; avoid antihistamine containing medications; pain at night can disrupt sleep; physical activity such as walking, stretching, rocking, or kicking often relieves pain. Make sure to exercise during the day
Caregiver fatigue support of the caregiver
Family members (e.g., spouse, children) care for most patients with PD. Their burden increases as the disease progresses. The caregiver’s physical and mental health may also decline. Help them find appropriate resources.
Loud therapy for parkinson’s
Pts have a hard time communicating, and it starts to affect their voice, and they have difficulty projecting their voices, so they go to loudness therapy to learn how to project their voices
Stroke can lead to emotional changes
A left-sided stroke can make the pt more prone to emotional outbursts; does not always correlate with how they are actually feeling. Include the pt in setting goals
Geriatric fluid and electrolyte imbalance causes
Structural changes in kidneys decrease the ability to conserve water. They are more at risk for electrolyte imbalance bc they can’t conserve water. Hormonal changes include a decrease in renin and aldosterone and increase in ADH and ANP. Subcutaneous tissue loss leads to increased moisture lost
Sodium range
1.35-1.45
Potassium range
3.5-5.0
Calcium range
9-10.5
Phosphate range
3-4.5
Magnesium range
1.3-2.1
Hypomagnesemia signs and symptoms
Resembles hypocalcemia; muscle cramps, tremors, hyperactive deep tendon reflexes, Chvostek’s and Trousseau’s signs confusion, vertigo, seizures, dysrhythmias
Fluid volume excess signs and symptoms
Weight gain, polyuria, bounding pulses, tachycardia, edema, HTN, JVD, dyspnea, crackles, pulmonary edema
SIADH monitor
Hyponatremia and decreased urine output
Hypocalcemia – Chovek’s
Contraction of facial muscles in response to a light tap over the facial nerve in front of the ear
Hypercalcemia – signs and symptoms
Fatigue, lethargy, weakness, confusion, hallucinations, seizures, coma, dysrhythmias, bone pain, fractures, nephrolithiasis, polyuria, dehydration
Insensible water loss examples
Sweating, breathing; things you cannot control
Hyperkalemia – medications
Patiromer (Veltessa), sodium zirconium cyclosilicate (ZS-9, Lokelma), and/or sodium polystyrene sulfonate (Kayexalate)
Potassium imbalances – assess
Potassium is important for the maintenance of cardiac rhythms, hypokalemia alters resting membrane
Eye assessment older adult:
Loss of orbital fat, decreased muscle tone; Dermatochalasis (excess upper lid skin), ptosis; Pinguecula (small yellowish spot usually on medial aspect of conjunctiva); Scleral color
Eye assessment older adult continued:
Decreased corneal sensitivity and corneal reflex; Loss of corneal luster; Blurred vision; dryness; Tearing, irritated eyes
Calcium – purposes in body
Formation of teeth and bones, blood clotting, transmission of nerve impulses, myocardial contractions, muscle contractions
Calcium concentration hormones
Parathyroid hormone (PTH)- increases bone resorption, GI absorption, and renal tubule reabsorption of calcium Calcitonin- increases calcium deposition into bone, increases renal calcium excretion, and decreases GI absorption
EKG – U waves
Normal potassium- shallow Hypokalemia- prominent
Parkinson’s patho
Lack of dopamine (DA), degeneration of DA-producing neurons, disrupts dopamine-acetylcholine balance in basal ganglia- essential for normal functioning of extrapyramidal motor system
Hypokalemia – signs and symptoms
Most serious is cardiac- it alters resting membrane; skeletal muscle weakness and paresthesia, weakness of respiratory muscles; decreased GI motility; hyperglycemia- impairs insulin secretion leading to glucose intolerance