Davide exam 1

Miosis

Constrcition of the pupil

glaucoma defininition

typically bilateral peripheral vision deficit from increased intra-ocular pressure, two types

Open-angle glaucoma definition

Common gradual vision loss, no pain, no s/s, not as urgent but you treat by lowering IOP

Closed-angle Glaucoma (narrow-angle, acute) definition

Sudden onset, no drainage of fluid buildup, pain, halos, N/V, emergency

How to Dx Glaucoma?

Tonometry- measures IOP, normal 10-21 mmHg

Tx of Glaucoma

Lifelong treatment of cholinergic agonists (pilocarpine), beta blockers (timolol), Prostaglandin analog (Latanoprost), but no cure just treatment of increased IOP, use drugs to constrict pupils

cataracts description

Blurry vision from cloudy lens, common with aging

Tx of cataract

Surgery to remove and replace cloudy lens, well tolerated, tell PT to report vision loss, pain, drainage, floaters. Avoid straining, bending, lifting, coughing. Encourage eye shield after.

Macular degeneration description

Central vision loss, most common cause of blindness in elderly, two types

Wet macular degeneration description

Sudden, rapid, bleeding vessels, uncommon. Tx anti-VEGF injections (blocks blood vessel growth), laser

Dry macular degeneration description

gradual blood vessel overgrowth, no cure but managing with healthy lifestyle choices and safety

Retinal detachmnt

Curtain/veil, Flashes, floaters. emergency surgery needed! pre-op, bedrest, eyepatch, dilating drops (mydriasis)

Mydriasis

pupil dilating

Otitis Media/externa

middle ear infection (red buldging TM, s/s ear pain, fever)

Outer ear infection (irritated canal, pain with tug)

Tx- antibiotics, wait watch, analgesics

Meniere’s disease description and Tx

•Triad: Vertigo + tinnitus + one sided hearing loss

•Unpredictable attacks, progressive condition, endolymph fluid builds w/in inner ear

Tx- salt restriction, diuretics, vestibular suppressants and therapy, fall and safety precaution, OR surgery, shunt (labyrinthectomy- total hearing loss as result, only severe refractory case

Acoustic neuroma description and Tx

CN VIII tumor which leads to hearing loss, tinnitus, and vertigo

Tx- surgery or radiation

Ototoxic drugs

Aminoglycosides, Loop diuretics, aspirin, vancomycin, cisplatin

What level should the nurse keep a COPD patient’s O2?

88-90%

Hypercapnia

excessive CO2, treat with pursed lip breathing

What do you do with Hypoxia or hypoxemia?

Assess lungs, give O2 as needed

What is usually described with cardiac pain

intense, crushing, that radiates to arm, shoulder, neck, also indicated by pericardial friction rub and/or anterior pain

What is usually described with pulmonary pain

Pain on deep inhale, end of inhale, or exhale, worse on inspiration indicates pulmonary issue, pulmonary pain is not made worse by pressing or touching the chest

OSA is associated with

Heart failure, hypertension, arrhythmias, uncontrolled epilepsy, temp. cognitive impairments, cerebral vascular accidents.

H F H A U E T C I C V A. Have fun hanging around union, eat the chocolate ice cream, very good! (silly, im sorry lol)

Epistaxis, causes and concerns?

Trauma, blood dyscrasia, pack or cauterize, posterior nasal bleeding is an emergency b/c airway obstruction and significant blood loss.

Xerostomia- cause, treatment, avoid

Dry mouth, usually from salivary gland cancer. Sip cool fluids, sugar-free candy/gum, dental consult, avoid alcohol

Asthma triggers

Allergens, infection, cold air, excercise, NSAIDs

How does someone Dx and then measure their asthma?

Dx with PFT (pulmonary function test)((hold bronchdilator before test)), and managed with peak flow meter (If in red, give asthma medication)

Meds to treat Asthma

Rescue: SABA(short-acting beta-agonist): albuterol- SE are increased HR, BP, tremors, and risk for arrhythmias

Maintenance- ICS (fluticasone), LABA (salmeterol), Anticholinergics (ipratropium)

What is ominous?

Sever chest silence

Cor Pulmonale

right-sided heart failure caused by chronic lung disease, such as COPD, which leads to high blood pressure in the lung's arteries (pulmonary hypertension) and puts strain on the heart's right ventricle. Symptoms include shortness of breath, fatigue, swelling in the legs and body, and chest pain.

Chronic bronchitis description

Blue bloater- inflammation in mucous hypersecretion

Emphysema

Pink puffer- Air trapped in alveoli, CO2 retention (pursed lip breathing can help)

Treatment of COPD

Bronchodilators, ICS (fluticasone), careful O2 (88-92%), pulmon. rehab, vaccines

Pulmonary hypertension description

Increased pressure in pulmonary veins, leads to rihgt ventricle pressure, can lead to COR pulmonale (R HF)

Pulmonary hypertension S/S

Dyspnea, Jugular vein distension, edema, hepatomegaly (enlarged liver)

Pulmonary hypertension Tx

Oxygen, meds: diuretics, digoxin, vasodilators (bosentan, sildenafil), prostacyclin (never interrupted, no piggyback), or heart lung transplant

Small cell lung cancer description

Less common, more aggressive, no surgery, paraneoplastic syndromes common, endocrine/hormone tumors, SIADH, insulin secreting tumor

Non-small cell lung cancer description

More common, surgery best option usually

Pneumonia description and how its Dx

S/s; cough, pleuritic pain, crackles. Elderly = confusion, 😱 Chest X-ray, sputum Tx antibiotics, O2, fluids, Vaccine, IS (?)

Chest Tubes- how should you find the water seal?

Tidaling

chest tubes- how should you find the suction chamber?

Continuously bubbling

Chest tubes- when should you report drainage?

report when >100 mL/hr of output, OR bright red drainage OR absent breath sounds

What do you do when a chest tube is pulled out from someone’s chest?

Cover incision site with sterile gauze and tape on three sides

what do you do when the chest tube is disconnected from the collection system?

If disconnected from system, clamp tubing, place end in sterile water, and call HCP/RT

Key notes to know for thoracentesis?

Sit upright, lean forward, only remove <1 L at a time, post op- check for breath sounds, O2, and watch for pneumothorax

Thoracentesis- definition

invasive medical procedure to remove fluid or air from the pleural space for diagnostic or therapeutic purposes

Why do we use bronchoscopy? what do we look for afterwards?

Dx and treatment of lung disorders, use lidocaine spray to num oropharynx, NPO till gag reflex returns

Alteplase (ATP)

powerful clot buster, used to tx pulmonary embolism, assess for s/s of bleeding indicated by hematocrit and hemoglobin

What lab values do you monitor for warfarin

Platelets, INR, PT

What lab values do you monitor for heparin

platelets, aPTT

Central line insertion precuations

assess for breath sounds after procedure, could be collapsed lung from puncture. 

What should you do if a patient forgot to stop their blood thinners before a surgery?

Immediately consult surgeon