here we go again. resp, integ, neursensory

help

triggers for migraines and cluster headaches

alcohol, allergies, intense odors, bright lights, fatigue, anxiety, hormone fluctuations

migraine expected findings

photophobia and phonophobia, n,v, stress, anxiety, unilateral pain, alteration in ADLs for 4-72 hr

migraine prodromal phase

awareness of findings for hours before onset

aura phase - migraine

numbness, tingling of mouth, lips, hands, face; acute confusion; visual disturbances

second migraine stage

severe, incapacitating, throbbing headache that intensifies over several hours and comes with n, v, drowsiness, vertigo

third migraine stage

4-72 hrs. headache is dull

the older client can experience an aura without

pain. this is called a visual migraine

status migrainous

longer than 72 hours.

migrainous infarction

neurological manifestations persist for 7 days, neuroimaging can indicate ischemic infarct

abortive therapy

to alleviate pain during aura or soon after start of headache. NSAIDS, tylenol, OTC anti-inflammatory agents for migraine, antiemetics. for severe you can give triptan preparations, ergotamine, isometheptene

triptan preparations

produce a vasoconstrictive effect

ergotamine preparations with caffeine

narrow blood vessels and reduce inflammation

isometheptene

in combination formulas when other meds do not work

preventative therapy

for frequent headaches or when other therapies are ineffective. NSAIDS with beta blocker, CCB, antiepileptic meds. onabotulinumtoxin A

foods that can trigger migraines

tyramine foods - pickles, caffiene, beer, wine, aged cheese, artificial sweeteners, MSG

medicines that can induce migraines

estrogen, nitroglycerin, nifedipine

which food should a nurse suggest a migraine patient should avoid

salted cashews bc nuts contain tyramine

a patient with a history of migraines and a new prescription for zolmitriptan indicates understanding with which statement

“i should expect facial flushing when i take this medication”

what are expected findings in someone with cluster headaches?

altered sleep-wake cycle, headache 1-8 times daily, nasal congestion and drainage

which instruction is pertinent for someone who was just diagnosed with migraines

apply a cool cloth to the face during a headache

which question should be asked to identify the aura type of migraine headaches

do you have the same manifestations each time the headache occurs

age related macular degeneration

central loss of vision that affects the macula of the eye. there is no cure and this is a common cause of vision loss in older adults

dry macular degeneration

most common and is caused by a gradual blockage in retinal capillary arteries which results in the macula becoming ischemic and necrotic due to lack of retinal cells

wet macular degeneration

less common than dry. caused by new growth of blood vessels that have thin walls that leaks blood and fluid. can occur at any age

risk factors of dry macular degeneration

smoking, hypertension, female, short body stature, family history, diet lacking carotene and vitamin e

opthalmoscopy

scope used to examine the back part of the eyeball (fundus) including the retina, optic disc, macula, and blood vessels

visual acuity tests

snellen and rosenbaum test

ocular injections with endothelial growth factor inhibitor

bevacizumab, or ranibizumab

medications that can cause cataracts

long term use of corticosteroids, phenothiazine derivatives, beta blockers, miotic medications

cataracts comorbidities usually

DM, hypothyroidism, down syndrome, chronic sunlight exposure

when should you start getting annual eye exams

after 40

cataracts

an opacity in the lens of an eye that impairs vision. decreased visual acuity, blurred vision, diplopia

eye meds

anticholinergic agents - atropine 1%. prevents pupil constriction for prolonged periods of time and relaxes muscles in the eyes. used to dilate the eyes preop for visualization of internal structures. fast onset, long duration. effects can last 7-12 days

activities that can increase IOP

bending over, sneezing, blowing nose, coughing, straining, head hyperflexion, restrictive clothing, sex.

glaucoma

disturbance of the functional or structural integrity of the optic nerve. decreased fluid drainage or increased secretion that can increase IOP and cause atrophic changes of the optic nerve and visual defects

frequent cause of blindness.

serotonin agonist that can be given for migraines

sumatriptan (imitrex)

expected range for IOP

10-21 mmhg

primary open angle glaucoma

more common form. open angle between iris and sclera. aqueous humor outflow is decreased due to blockages in the eye’s drainage system causing a gradual rise in IOP

primary close angle glaucoma

IOP rises suddenly. the angle between the iris and sclera suddenly close causing a corresponding increase in IOP. sudden onset and requires immediate treatment

secondary glaucoma

can result from trauma, eye surgery, tumors of the eye, uveitis, irisitis, neurovascular disorders, degenerative disease or central retinal vein occlusion

findings for primary open angle glaucoma

headache, mild eye pain, loss of peripheral, decreased accommodation, halos around lights, elevated IOP (22-32 mmhg)

findings in primary angle closure glaucoma

rapid onset elevated IOP (30 mmhg or higher) decreased or blurred visions, colored halos around light, pupils nonreactive to light, severe pain and nausea, photophopbia

tonometry

measures IOP

gonioscopy

used to determine the drainage angle of the anterior chamber of the eyes

if multiple eye drops are prescribed

wait 5-10 min between drops to keep them from diluting each other

cholinergic agents

carbachol, echothiophate, pilocarpine - miotic meds that constrict the pupil and allows for improved circulations and outflow of the aqueous humor. can cause blurred vision

pilocarpine good second-line drug for POAG

adrenergic agonists

apraclonidine, brimonidine, tartrate, dipivefrin hcl. reduces IOP by limiting production of aqueous humor and dilates the pupils to improve the flow to the sight of absorption

beta blockers (opthalmic)

timolol. first line drug therapy for glaucoma, and decrease IOP by reducing aqueous humor production.

can be absorbed systematically and cause bronchoconstriction and hypoglycemia. caution in those with asthma, COPD, and DM

carbonic anhydrase inhibitors

acetazolamide, dorzolamide, brinzolamide - decrease IOP by reducing aqueous humor production. THIS IS A SULFA BASED DRUG

prostaglandin analogs

bimatoprost, latanoprost. increase outflow fot eh uveosclera by dilating blood vessels in the trabecular mesh where aqueous humor is collected and then drains the humor at a more rapid rate

check for corneal abrasions and dont instill if cornea not intact. can cause iris to darken with long term use

systemic osmotics

mannitol and oral glycerin. mannitol used in emergency for POAG to quickly decrease IOP

glaucoma surgery

laser trabeculetomy, iridotomy, or placement of a shunt are procedures used to improve the flow of the aqueous humor by opening the channel out of the anterior chamber of the eye

patient has DM and reports a gradual loss of peripheral vision

POAG

postoperative teaching for cataracts surgery. which treatment should the nurse include

you need to limit your housekeeping activities

a nurse is caring for a male older adult client who has a new diagnosis of glaucoma. what are some risk factors associated with this disease

genetic predisposition, hypertension, age, dm

what are some manifestations of cataracts

blurred vision and white pupils

what teaching should be given to someone with dry macular degeneration

increase dietary intake of caretenoids and antidioxidants to slow the progression of macular degeneration

components of the middle ear

tympanic membrane, malleus, incus, stapes, and connects from the nasopharynx via the eustachian tube

the inner ear consists of

cochlea, semicircular canals, cranial nerves vii and viii. located within the temporal bones separated from the ear by the oval window

sensorineural hearing loss is caused by

damage to cranial nerve viii

combined hearing loss is caused by

a mixture of conductive and sensorineural problems

age related ear changes

thickening of the tympanic membrane from loss of elasticity, loss of sensory hairs in the organ of Corti, and limitations to movement of the ossicles

acute otitis media

viral or bacterial infection of the middle ear

vertigo

occurs when the client has the sensation that they or their surroundings are in motion

benign paroxysmal positional vertigo

response to a change in position. thought to be caused by disruption of debris located within the semicircular canal (small crystals of calcium carbonate) sudden onset and can last a few weeks or years. bed rest prescribed

labyrinthitis

inflammation of the labyrinth often secondary to otitis media.sudden onset of severe vertigo, n, v, possible hearing loss and tinnitus. bed rest and meclizine, dimenhydrinate. antibiotics can also be prescribed

menieres disease

episodic vertigo, tinnitus, and fluctuating sensorineural hearing loss

inner ear disorders usually caused by

viral or bacterial infection or damage due to ototoxic meds

expected findings for middle ear disorders

hearing loss, feeling fullness or pain in the ear, red and inflamed ear canal and TM, bulging TM, fluid or bubbles behind TM, fever

expected findings with inner ear disorders

hearing loss, tinntus, dizziness, vertigo, vomiting, nyastagmus, alterations in balance

audiometry

noninvasive test of hearing ability including pitch, frequency, tone, and intensity. client indicated when a tone is heard through headphones

tympanogram

measures the mobility of the TM and middle ear structures relative to sound (effective in diagnosing middle ear disease)

electronystagmography

detects involuntary eye movements in order to assess for disease of the vestibular system of the ear. electrodes taped near the eye and eyes are recorded when ear is stimulated with cold water or air. dont use on patients with a pacemaker

ototoxic medications

gentamicin, erythrimycin, furosemide, ethacrynic acid, aspirin, ibuprofen, cisplatin

meclizine

has antihistamine and anticholinergic effects and is used to treat the vertigo that accompanies inner ear problems

effects of meclizine

be aware of the sedative effects and avoid driving and operating heavy machinery

ondansetron

one of the antiemetics used to treat nausea and vomiting associated with vertigo. do not use if patient has arrhythmias, and alert provider if rash or dizziness appears

diphenhydramine and dimenhydrinate

antihistamines are effective in the treatment of nausea and vomiting that accompany inner ear problems. observe for urinary retention, sedation. DRY MOUTH is expected

scopolamine

anticholinergic effective in treatment of nausea that accompanies inner ear problems. can be used transdermally and for motion sickness. observe for urinary retention and sedation. monitor patients with POAG for IOP. contraindicated for those with PACG. dry mouth.

diazepam

bendodiazepine that has a sedative effect that deceases stimulation to the cerebellum. restrict use in those with PACG. be aware of sedative and addictive properties

point pressure treatment

involves inserting a tympanostomy tube that applies micropulses in intervals to relieve vertigo caused by menieres disease by displacing fluid in the inner ear

stapedectomy

removal of the stapes and replacement with a prosthesis

client education following middle ear surgery

avoid air travel 2-3 weeks. avoid straining or coughing and blow nose gently for 2-3 weeks following surgery. keep canal clean and dry and avoid showering for a few days up to a week. expect hearing loss in affected ear and report drainage to provider

on an otoscopic exam what is an unexpected finding

fluid or bubbles behind TM

What are some of the expected findings on someone who has severe otitis media

enlarged tonsils and adenoids. report of recent colds

what are some actions to suggest to control vertifo

reduce light expose, move head slowly when changing positions, evenly spaced daily fluid intake, avoid caffeine

what is an expected finding for menieres disease

unilateral hearing loss

after having middle ear surgery, which statement indicates understanding

i should restrict rapid movements and avoid bending at the waist for a few weeks

rhinitis

inflammation of the nasal mucosa and often the mucosa of the sinuses that can be viral, bacterial, or caused by allergens. when caused by an allergen there can be localized edema and swelling. virus is the coryza virus

sinusitis

inflammation of the mucous membranes of one or more sinsues (usually maxillary and frontal). blocks drainage of secretions which can cause a sinus infection.

upper respiratory potential complications

obstruction, hemorrhage, sepsis, meningitis or brain abcess, acute otitis media, dysphagia, aphonia, cellulitis

drug therapy for glaucoma

beta-adrenergic blockers (betaxolol, timolol), cholinergic agonists (pilocarpine), cholinestersase inhibitors (echothiophate)

drugs for non-infectious lower respiratory airflow disorders

albuterol, atrovent (anticholinergics), theophylline, prednisone, singulair,

drugs for upper respiratory disorders

benadryl, zyrtec, phenylephrine, codeine, dextromethorphan, mucines, acetadote

contraction of bronchial smooth muscle

seen in asthma

thickening of bronchial mucosa

as seen in chronic bronchitis

obstruction of the airway

as seen with mucus, foreign body, or tumor

loss of lung elasticity

as seen in emphysema

as people get older the alveoli

have less surface area than before, decreased diffusion capacity, unable to move air rapidly in and out of the lungs, decreased tolerance

pharyngitis

Painful inflammation of the the pharynx, can be bacterial or viral. can be caused by serious and hard to cure bacteria. swollen lymph nodes and usually no cough. can lead to abscess, otitis media, sepsis pneumonia