Med Surg 1 - Test 1/Quiz 1

Nystagmus

Involuntary rapid eye movements

Strabismus

crossed eyes

Myopia

nearsightedness (can't see things far away)

Astigmatism

distortion caused by irregularity of the cornea

Mydriatics

Dilate the eye (contraindicated for narrow angle glaucoma)

CANNOT GIVE TO PATIENTS TAKING MAOI's OR TRICYCLIC ANTIDEPRESSANTS

Glaucoma

increased IOP causes mechanical damage
risk increases with age
Aqueous production and drainage are not in balance

signs/symptoms: vision loss, blurring, halos, difficulty focusing,
aching/discomfort around the eyes, or headache.

tested with: tonometry, ophthalmoscopy, and central vision field testing
treated with: miotics, beta-blockers, alpha1-agonists, carbonic anhydrase inhibitors, and prostaglandins

Cataracts

opacity or cloudiness of the lens
risk factor: increased age
traumatic, congenital, and senile

signs/symptoms: painless, blurry vision, surroundings dimmer. reduced visual acuity. sensitivity to glare.
tested with: ophthalmoscope, slit lamp, or inspection
treated with: surgery
- phacoemulsification: the lens is sucked out through a tube
- lens replacement: surgeon inserts an intraocular lens implant

DONT BEND OR STOOP AFTER SURGERY

Retinal detachment

two layers of the retina separate from each other
- assess visual acuity
- ophthalamascope, slit lamp, tomography, and ultrasonography

scleral buckle

compress sclera

Weber test

detects unilateral hearing loss through bone conduction

Rinne test

bone vs air hearing conduction

sensorineural hearing loss

caused by damage to the cochlea or vestibulocochlear nerve

Mixed hearing loss

both conductive and sensorineural

Functional (psychogenic) hearing loss

caused by emotional problem

Cerumen impaction

buildup of ear wax blocking ear canal
- removal through irrigation, suction, or instrumentation
- mineral oil or peroxid may be used to soften the ear wax

External otitis

inflammation of the external ear
- commonly caused by bacteria or fungus
- also called swimmers ear
- pain, purulent discharge, tenderness

Otalgia

pain/fullness in the ear

Meniere Disease

disorder of the labyrinth of the inner ear; elevated endolymph pressure within the cochlea and semicircular canals

FALL RISK - ask for assistance, call light, bed alarm, get rid of rugs

- signs/symptoms: vertigo, tinnitus, fluctuating sensorineural hearing loss
- treatment: low sodium diet, meclizine, valium, and surgical management

Petechiae

small, pinpoint hemorrhages from capillaries

Patch (primary)

a flat, discolored area on the skin larger than 1 cm (bigger than a macule)

Papule (primary)

Superficial, elevated lesion up to 1 cm

Vesicle (primary)
- small blister

Elevated < 1 cm; a "blister", clear serum flows if wall is ruptured ex. herpes simplex, chickenpox, shingles

Wheal (primary)

Irregular, transient, superficial area of localized skin edema
urticaria = more than 1 skin wheel

Cyst (primary)

encapsulated fluid-filled cavity in dermis or subcutaneous layer, tensely elevating skin

Erosion (secondary)

Scooped out but shallow depression. Superficial; epidermis lost; moist but no bleeding; heals without scar because erosion does not extend into dermis.

Scar (cicatrix) (secondary)

Skin mark left after healing of a wound or lesion; represents replacement by connective tissue of the injured tissue
Young scars: Red or purple
Mature scars: White or glistening

petechiae

small, pinpoint hemorrhages

Ecchymosis

bruise

Skin scrapings

used to diagnose fungal lesions

Tzanck smear

used to diagnose blistering skin conditions ex. chickenpox, herpes zoster/simplex, varicella

Impetigo

bacterial infections (staph, strep, MRSA) CONTAGIOUS
family cannot touch/share items

treatment: antibiotics

herpes simplex
simplex 1 = cold sore
simplex 2 = genital blisters

CONTAGIOUS
treatment: antiviral medications and prophylactic medications
dont kiss babies

Pediculosis

Pediculosis capitis- treatment: lindane (kwell), pyrethrin (RID) and heat
Pediculosis corporis- bath in soap and water and apply scabicide
Pediculosis pubis-check for coexisting STDs

Vitamin C

vital for collagen synthesis

Rhinitis and Rhinosinusitis

Rhinitis (runny nose) and Rhinosinusitis (full sinus)

acute, chronic, bacterial, and viral
treatment: PUSH FLUIDS. hot pack to reduce congestion
Neck stiffness (nuchal rigidity): If it turns into bacteria--there is a risk of meningitis

medicamentosa: drying of the nose caused by overuse of nasal spray

Laryngitis

voice loss

Epistaxis

nose bleed

treatment: AFRIN (phenylephrine) spray = vasocontriction, pressure. ice collar to reduce inflammation and bleeding

Eosinophils and Basophils

allergic reactions

Neutrophils

mature, first line of defense

bands (baby neutrophils): shift left--sign of immediate/new infection

iron deficiency anemia (hypoproliferative)

diagnosed with labs: hemoglobin and hematocrit, RBC, iron studies, bone marrow asp.
signs/symptoms: fatigue, weakness, malaise, pallor/jaundice, resp/cardia symptoms, pica, nail changes
treatment: eat more iron and vit. C
can cause black bowel movements

DECREASE FATIGUE AND MAINTAIN NUTRITION

Megaloblastic anemia (turn big due to defect in factory)

folic acid and B12 deficiency (cells get stuck on conveyor belt and grow large)

Pernicious anemia = B12 anemia could possibly be a vegetarian

diagnosed with labs: hemoglobin and hematocrit, RBC, iron studies, folic acid and B12, bone marrow asp.
signs/symptoms: fatigue, weakness, malaise, pallor/jaundice, resp/cardia symptoms, pica, nail changes

sodium-potassium pump

ACTIVE TRANSPORT (requires energy)
keeps the cell in electrolyte check

Every 3Na+ out = 2 K+ in (and vise versa)
There should always be more potassium in the cell

Fluid Volume Deficit (FVD)

hypovolemia
mostly caused by:
- hemorrhage=loosing blood (1st reason)
- diarrhea/vomiting=loosing electrolytes (2nd reason)
- may be caused by burns

symptoms: low temp, high HR, low BP, lab levels, elderly: congusion/cognition
treatment: I&Os every 8 hr and daily weights

dehydration is not the same of FVD
ORAL FLUIDS ALWAYS PREFFERED

Fluid Volume Excess (FVE)

hypervolemia
mostly caused by:
- kidney disease
- too much intake of sodium
- heart failure

symptoms: edema, distended neck veins, crackles in the lungs, decreased concentration of HCT and BUN (more fluid=diluted)
treatment: I&Os every 8 hr and daily weights (output > input), diuretics (flush out the fluid) and dietary restriction of fluids and sodium

look for signs of cerebral edema

Hypokalemia

low potassium (<3.5) caused by:
- diarrhea
- hyperaldosteronism

manifestations: heart problems (ECG changes and dysrhythmias)
treatment: oral/diet intake of potassium or IV. monitor ECG and ABGs

hypophosphatemia

low phosphate (<2.7) caused by:
- bowel problems and lots more

manifestations: confusion and muscle pain
treatment: oral supplements/diet, IV (CHECK IV SITE for tissue damage or necrosis)

metabolic alkalosis

caused by vomiting and NG

respiratory acidosis

caused by major lung issues, puncture, PE
MOST LIKELY VENT

respiratory alkalosis

always caused by hyperventilation

Vertigo

the illusion of motion or a spinning sensation
Benign positional veritgo (BBPV): triggered by specific changes in position and the loosening/movement of calcium crystals in the ears

Acoustic neuroma

tumor of the VIII cranial nerve (vestibulocochlear)

Laryngectomy

surgical removal of the larynx to avoid cancer
(still have vocalization and the ability to eat)

Amblyopia

lazy eye

Emmetropia

normal vision 20/20

Hyperopia

farsightedness (can't see things close up)

Blindness

Legal blindness = 20/200

Low Vision

visual impairment that requires the use of devices and strategies in order to see--often accompanied by functional impairment
- placement of items in room
- clock method on tray
- braille and service animals

MAY ALSO BE CAUSED BY RETINAL VEIN OR ARTERY OCCLUSION

Blinking

lowers the size of the conjuntival sac = less absorption

Apnea

temporary cessation of breathing. Weight of the chest pushes on the lungs

major risk: obesity
signs/symptoms: open mouth breathing and snoring. groggy (daytime sleepiness), short of breath, weak, headache

Cycloplegics

paralyze the eye

CANNOT GIVE TO PATIENTS TAKING MAOI's OR TRICYCLIC ANTIDEPRESSANTS

Glaucoma meds

increase aqueous outflow or decrease aqueous production
may constrict the pupil.
example: atropine

Tonometry

the measurement of intraocular pressure

Corneal Dystrophies

deposits in the corneal layers (keratoconus and fuchs)

Retinal vascular disorders

-Central retina vein occlusion
-Branch retinal vein occlusion
-Central retinal vein occlusion
-Macular degeneration

vitrectomy

surgical removal of all or part of the vitreous humor (bubble)

age related macular degeneration (AMD)

a condition in which the macula degenerates, gradually causing central vision loss and blindness (leading cause of blindness)

slow break down of retina layers. (wet type: proliferation of blood vessels under retina)

conjunctivitis

inflammation of the conjunctiva (pink eye)
classified by cause
viral and bacterial conjunctivitis are contagious
symptoms: hyperemia

uveitis

inflammation of the uvea

orbital cellulitis

An infection within the eye socket.

diabetic retinopathy

damage to the retina as a complication of uncontrolled diabetes=blindness

Flushing

only flush when the corneal surface is intact

Conductive hearing loss

caused by external of middle ear problem

Tinnitus

perception of sound (often called ringing in the ears)

Foreign bodies

- removal through irrigation, suction, or instrumentaiton
- objects that may swell (vegetables or insects) should not be irrigated

Malignant otitis externa

rare. effects external auditory canal and surrounding tissues/skull

Dizziness

any altered sense of orientation in space

Labyrinthitis

inflammation of the labyrinth

Ototoxicity

damage to the organs of hearing by a toxic substance (induced by drugs)

Cochlear implant

prosthesis for people with bilateral sensorineural hearing loss who cannot use conventional hearing aids

ABCDEEFG

Asymmetry
Borders
Color
Diameter
Evolving
Elevated
Firm
Growing

Corticosteriods

anti-inflammatory agents that treat skin inflammation (can decrease wound healing)

Erythema

reddness

Pruritus

itching

Primary lesions

initial lesions that are characteristic of a disease

Secondary lesions

lesions that result in changes in primary lesions
- scratching, trauma, infections, wound healing

Macule (primary)

flat, discolored spot on the skin
ex. port wine stains

Plaque (primary)

Superficial elevated lesion, 1cm or larger

Nodule/tumor (primary)

elevated, solid, palpable mass with irregular border- may be malignant (cancerous) or benign ex. tumor

Bulla (primary)
- big blister

Elevated blister > 1 cm, clear serum inside

Pustule (primary)

turbid fluid (pus) in cavity; circumscribed and elevated; ex - impetigo, acne

Ulcer (secondary)

deeper depression extending into dermis, irregular shape; may bleed; leaves scar when heals

Fissure (secondary)

a linear crack in the skin

Scales (secondary)

flakes of skin, sheds excess keratin (eczema)

Crust (secondary)

dried residue of skin exudates such as serum, pus, or blood
impetigo = yellow crust

Keloid (secondary)

Thick scar resulting from excessive growth of fibrous tissue

Atrophy (secondary)

Thinning of the dermis or epidermis causing depression in the skin. (happens in old age)

Lichenification (secondary)

prolonged, intense scratching eventually thickens skin and produces tightly packed sets of papules; looks like surface of moss

psoriasis and eczema

Cherry angioma

a small, round, bright red blood vessel tumor on the skin, often on the trunk of the elderly

Pruritis

Itching associated with most forms of dermatitis.

treatment: reduce heat and humidity! Hygiene. Corticosteroids and antihistamines

herpes zoster (shingles)

viral infection affecting peripheral nerves caused by previous varicella (reactivation and distribution along the nerve symplex)

3 phases: pain, vesicle formation (raised, red, and pussy), and nerve pain

signs/symptoms: vesicles (blisters), pain, linear formation
treatment: antiviral medications, pain medication
complications: is disease is close to eye = trigemenal nerve complications