Bridge Focus Exam #2 Review

SBAR

• Stands for: Situation, Background, Assessment, Recommendation

Stroke Risk Factors

• Age, gender, ethnicity/race (Blacks at higher risk), family history, heredity

• HTN, heart disease, DM, elevated cholesterol, smoking, excess alcohol, metabolic syndrome

Weber Test

• Normal: Hearing sounds equally bilaterally

• Abnormal: Hearing sounds on one side only

Retinal Detachment Signs and Symptoms

• Flashes of light, floaters, "cobweb"/"hairnet"/ring in vision

• Gradual loss of peripheral/central vision, "like a curtain" effect

• No pain

PE Tubes (Pressure Equalization Tubes)

• Also known as Myringotomy/Tympanostomy tubes

• Purpose: better hearing by relieving fluid buildup

• Precautions: Wear earplugs for swimming or water activities

• Infection: Drainage occurs; if purulent drainage or fever, notify HCP

Child Eye Surgery: Reducing IOP and Ensuring Room Safety

• Parents allowed in pre and post-op (not OR) for comfort.

• Minimize crying to prevent increased IOP.

• Remove safety hazards from the room.

Snellen Chart

• Viewed from 20 feet away.

• Example: 20/40 vision means seeing at 20 feet what someone with 20/20 vision 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 (bending, stooping, coughing, lifting).

• Head positioning: Semi-Fowler’s position.

• Proper eye care and hygiene.

• Report S&S of infection: increased/purulent drainage, increased redness, decreased visual acuity.

• Proper instillation of eye medication, pain management, and importance of follow-up.

• Measures to cope with vision loss (large screens, audiobooks, additional lighting) and promote safety.

Beta-Blocker Eye Drops Contraindications

• Bradycardia, 2nd/3rd-degree heart block, cardiogenic shock, heart failure.

• Noncardioselective β-adrenergic blocking glaucoma agents contraindicated in COPD or asthma.

• Profound effects in older patients.

Glaucoma Medications Purpose

• Decrease pupil size (miosis).

• Increase outflow of aqueous humor.

• Decrease IOP.

• Note: Does not change the volume of vitreous humor.

Communication Techniques for Sensorineural Hearing Loss

• Nonverbal aids: hand movements, face in good light, eye contact, clear face mask, avoid chewing/eating/smoking while talking, remove background noise, move closer to better ear.

• Verbal aids: speak normally and slowly (do not shout), do not exaggerate facial expressions/overenunciate, use simple sentences, rephrase using different words, write down names/difficult words, speak in normal voice directly into good ear.

Age-Related Macular Degeneration Assistive Devices

• Sunglasses, extra lighting, daytime driving, assistive devices (larger print, magnifying glass).

Furosemide and Tinnitus

• Furosemide can cause tinnitus and hearing loss.

Parkinson’s Eating and Assistive Devices

• Dysphagia and bradykinesia: appetizing foods that are easy to chew and swallow.

• Diet: adequate fiber to reduce constipation.

• Cut food into small bite-size pieces; gyroscope utensils.

MS Infection Risks

• Incontinence and UTIs are common.

• Death usually occurs from infection (pneumonia) related to immobility.

ALS Nursing Interventions

• Support the patient and caregivers emotionally (grieving motor function loss and impending death).

• Discuss advance directives and artificial ventilation.

• Provide caregiver support and resources.

Huntington’s Disease Genetics

• Genetically transmitted autosomal dominant disorder.

• 50% chance of child developing it if one parent has it.

MS Medication Therapy Evaluation

• Medication is effective when symptoms improve.

Myasthenia Gravis Medication Schedule

• Inadequate dosing: myasthenic crisis.

• Excessive dosing: cholinergic crisis (too much cholinesterase inhibition).

• Cholinergic crisis symptoms are similar to myasthenic crisis. Features include involuntary muscle contraction, extreme weakness, flaccid muscle paralysis, sweating, excessive salivation, diarrhea, constricted pupils.

RLS Interventions

• Lifestyle changes: decrease caffeine/alcohol/tobacco, regular sleep habits, daily mild to moderate exercise, relaxation techniques, leg massage/stretching.

• Avoid antihistamine-containing medications.

• Pain at night disrupts sleep; physical activity relieves pain.

Caregiver Fatigue

• Family members care for most patients with PD, caregiver burden increases as the disease progresses, caregiver’s physical and mental health may decline; help them find appropriate resources.

Dyskinesia

• Spontaneous, involuntary movements

Loud Therapy for Parkinson’s

• Patients have a hard time communicating and projecting voices, so they learn how to project their voices.

Stroke Emotional Changes

• Left-sided stroke: prone to emotional outbursts (doesn't always correlate with actual feelings).

• Include the patient in setting goals

Geriatric Fluid and Electrolyte Imbalance Causes

• Structural changes in kidneys decrease the ability to conserve water.

• At risk for electrolyte imbalance due to inability to conserve water.

• Hormonal changes include decreased renin and aldosterone and increased ADH and ANP.

• Subcutaneous tissue loss leads to increased moisture loss.

Electrolyte Ranges

• Sodium: 1.35-1.45

• Potassium: 3.5-5.0

• Calcium: 9-10.5

• Phosphate: 3-4.5

• Magnesium: 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 serum sodium, hyponatremia, hyponatremia and decreased urine output.

Hypocalcemia – Chvostek’s Sign

• Contraction of facial muscles in response to a light tap over the facial nerve in front of the ear.

Potassium Administration

• NEVER PUSH OR BOLUS POTASSIUM!!! Always on a drip, always dilute, do not exceed 10 mEq/hr.

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 Heart Rhythm

• Potassium is important for the maintenance of cardiac rhythms; hypokalemia alters resting membrane.

Eye Assessment Older Adult

• Lens opacity, decreased elasticity – issues with night vision and glare.

• 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.

• Yellowish as opposed to bluish; Cholesterol deposits in peripheral cornea; Tissue damage related to chronic exposure; Decrease in water content, atrophy of nerve fibers; Decreased corneal sensitivity and corneal reflex; Loss of corneal luster; Blurred vision; dryness; Tearing, irritated eyes; Decreased pupil size; Slow recovery of pupil size after light stimulation; Change of iris color; Decrease in near vision and accommodation; cataracts; presbyopia; Reports of glare, night vision impaired; Yellow color of lens; Narrowed, pale, straighter arterioles. Acute branching; Changes in color perception, especially blue and violet; Decreased visual acuity; Loss of central vision, presence of yellow deposits, atrophy of macular retinal pigment; Increased “floaters”.

Monitor F&E Balance with Diarrhea

• Potassium imbalance.

Delegation to UAP for Increasing Fluid Intake

• UAP can be delegated to encourage patient to drink more water.

EKG – U Waves

• Normal potassium- shallow.

• Hypokalemia- prominent.

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.

Parkinson’s Patho

• Exact cause is unknown. 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.