Download NURSG 331 Exam 2 Study Guide Latest Update 2023 Guaranteed A+ and more Exams Nursing in PDF only on Docsity!
NURSG 331 Exam 2 Study Guide
Latest Update 2023 Guaranteed
A+
Visual and Auditory Problems module (1 part) not as heavily covered as other 2 mods WebEx Notes o Eyes and ears not part of Final exam o Glaucoma, MD, Cataracts - know treatment, clinical manifestations o Hearing- know nursing care of the hearing impaired
- Glaucoma * pressure & peripheral vision *
- [Lewis Table 20.12, 20.13] o Normal intraocular pressure: 10 to 21 mm Hg o Can lead to structural damage. ▪ Optic nerve damage ▪ Loss of peripheral vision o Inflow > outflow IOP increases vision loss o Risk Factors ▪ Black people over 40 ▪ All persons over 60 ▪ Family history!! - Strong genetic link ▪ Open angle - Blockage is NOT at the entrance, but inside - Primary Open-Angle Glaucoma (POAG) o Most common: 60% of all glaucoma o Slow onset- S/S are often unnoticed because no pain or pressure. o Usually bilateral, leads to tunnel vision o Common in diabetics o Cause o Blockage of aqueous fluid drainage increasing IOP cupping of the optic disc destroys retinal nerve fibers painless vision loss. o IOP: 22 – 32 mm Hg - Symptoms o Asymptomatic early o Change in peripheral vision o Bumping into objects
o Many assume normal aging changes o Dx : elevated IOP (22-32mm/Hg), visual field loss, cupping of optic nerve
- Treatment o Medications ▪ Miotic Drops - pupil constriction and reduce formation of aqueous humor - Sx: burning, blurred vision ▪ Beta Blockers - Decreases production of aqueous humor - Sx : burning, tearing, slowed HR, fatigue ▪ Topical Steroids
▪ Use of eye drops ▪ Prevent increase of IOP ▪ Avoid bending
- Raise foot to tie shoe
- Push heavy objects (don’t pick up/lift) ▪ Avoid steroids
- Steroids increase IOP ▪ ID band ▪ Avoid sneezing, coughing
▪ Contact MD if sudden painless loss of vision ▪ Take drops
- Burning & blurring vision are short lived - Macular degeneration central vision loss o Most common cause of central vision loss in people over 60 in the US o Types Dry vs. Wet ▪ Dry (nonexudative)
- More common: 90% of cases
- Slowly progressive macular atrophy
- Causes painless vision loss and accumulation of yellowish (drusen) deposits ▪ Wet (exudative)
- More severe that leads to blindness with a rapid onset
- From abnormal blood vessels near macula o Leak and cause scar tissue
- Had dry first o Causes ▪ Aging, genetics, UV exposure, smoking ▪ Hyperopia ▪ Light colored eyes ▪ Lack of nutrient intake
- Eating dark leafy green vegetables (kale and spinach) may reduce risk o Need more Vit. C, E, lutein, zeaxanthin and zinc o Increased incidence : White people o S/S ▪ Blurred vision, dark (blind) spots, and visual distortions o Care ▪ No smoking ▪ Vitamin/mineral supplements ▪ Intraocular injections of endothelial growth factor inhibitors
- For Wet MD ▪ Photodynamic therapy: uses an IV med and a cold laser.
- It takes days for the dye to pass which is activated by light.
- The patient MUST be covered and stay out of light for at least 5 days or they could suffer burns!
- Cataracts opacity within the lens
- [Lewis Table 20.8, 20.9] o Loss of transparency of the lens o #1 cause of blindness o Caused by chemical changes ( normal aging ) within the protein material of the lens clouding, yellow or brown discoloration o Contributing factors ▪ Sunlight ▪ poor nutrition ▪ Smoking
▪ Diabetes mellitus o Common ▪ 25% of population, over 55. Over 22 million globally o Myths ▪ Not caused by over-using eyes, Not contagious or R/T cancer, Not a film or coating, Not spread from eye-to-eye o Symptoms ▪ No known means to reverse clouding ▪ Usually bilateral ▪ Like looking through foggy window ▪ Painless , progressive loss of vision ▪ Abnormal color vision ▪ Glare, esp at night
- Bad for night driving ▪ Amount of vision loss R/T location & degree of clouding o Treatment ▪ Prescription glasses
- Central vision is corrected, peripheral vision is distorted
- 30% magnification o Adjustment needed for ADL’s (judging distances) ▪ Surgery
- Must assess vision of un-operative eye
- Outpatient, one eye at a time
- Removal of the clouded lens and replaced with an intraocular lens implant (IOL). o Allows the eye to focus again clearly
- Proper eyewear can further enhance vision ▪ Sometimes informing and reassuring the patient about the disease process makes the patient comfortable about choosing nonsurgical measures, at least temporarily. o Post-op Care & Complications ▪ Care
- After sedatives wear off, patients are usually go home.
- Permanent glasses prescribed after 3 months
- Usually discharged with eye drops
- Call MD if increased pain in operative eye o PT SHOULD NOT HAVE PAIN - Avoid increase of IOP o Activities: bending or stooping, coughing, or lifting.
- Clean inner outer
- Shaded lenses, eye shield o Nighttime eye shielding
- Showers, hair washed with head held backward
- Sex in 6-8 weeks - Postoperative medications o Antibiotic drops (prevent infection) o Corticosteroid drops (decrease post-op inflammation)
- During each postoperative examination, the ophthalmologist will measure the patient’s visual acuity, check anterior chamber depth, assess corneal clarity, and measure IOP. ▪ Complications
WebEx Notes o Knowing type 1 and 2, hypo and hyperglycemia – what does it look like, what do we do for these, what teaching can we do (lot of teaching with DM) o Diabetes insipidus- has NOTHING to do with blood sugar- has more to do with fluids o Know normal blood sugar ranges, A1C, some electrolytes that play into this
Table 48.1: Differences between Type 1 & 2 pg. 1109 Table 48.2: Interprofessional Care
- Diagnostic Assessment o History and physical exam o Blood tests: fasting BG, postprandial BG, A1C, fructosamine, lipid profile, BUN and serum creatnine, elecrrolytes, islet of cell autoantibodies o Urine analysis o BP o ECG (if indicated) o Funduscopic exam (dilated eye exam) o Dental exam o Neurological exam o Ankle-brachial index (ABI) o Food (podiatric) exam o Monitoring of weight
- Management o Pt and caregiver teaching & follow-up programs o Nutrition therapy o Exercise therapy o Self-monitoring BG
- Drug Therapy o Insulin o OA Type 1 diabetes
- Cause o Autoimmune disorder in which the body develops antibodies against insulin and/or the pancreatic β cells that produce insulin. This eventually results in not enough insulin for a person to survive. o Autoantibodies to the islet cells cause a reduction of 80% to 90% of normal function before hyperglycemia and other manifestations occur. ▪ May take months to years before S/S occur
- Clinical Manifestations o Onset is rapid, 1 st manifestations are usually acute o Polyuria, polydipsia & polyphagia (3 P’s) ▪ Osmotic fx of excess glucose polydipsia & polyuria ▪ Cellular malnourishment from insulin deficiency prevents cells from using glucose for energy
- 30 days for one insulin o Typically injected subcutaneously ▪ Intramuscularly can cause rapid or unpredictable absorption which can cause hypoglycemia o Insulin pump ▪ users check their blood glucose level at least four times per day. Monitoring eight times or more per day is common. ▪ Advantage: keeps blood glucose levels in a tighter range because insulin delivery becomes very similar to the normal physiologic pattern. o Complications ▪ Hypoglycemia, allergic reactions, lipodystrophy, and the Somogyi effect. ▪ Local inflammatory reactions: itching, erythema, and burning sensation around the injection site.
- Local reactions may be self-limiting within 1 to 3 months or may improve with a low dose of antihistamine. ▪ A true insulin allergy is rare. It is manifested by a systemic response with urticaria and possibly anaphylactic shock.
- Zinc or protamine, used as preservatives in the insulin, and the latex or rubber stoppers on the vials have been implicated in allergic reactions. ▪ Lipodystrophy (atrophy or hypertrophy of subcutaneous tissue) may occur if the same injection sites are used frequently.
- The use of hypertrophied sites may result in erratic insulin absorption.
- Diabetic Ketoacidosis (DKA) o Causes: decreased or missed insulin dose, illness or infection, untreated diabetes
o S&S: acetone breath, low BP, hyper or hypokalemia, metabolic acidosis,
anorexia, nausea, vomiting, abdominal pain, increased RR, blurred vision, polyuria, weakness, HA, polydipsia, hypotension, tachycardia, sunken eyes, slow turgor. o Metabolic Acidosis ▪ hyperkalemia hypokalemia (watch very closely) o Treatment ▪ fluid resuscitation ▪ Low dose IV insulin in .9 NS
- lower slowly to prevent rebound cerebral edema, add D5 to solution once BS at 250 (prevents severe hypoglycemic drop) ▪ Follow sick day rules to prevent DKA r/t illness
- Take insulin/oral agents as usual
- Acuchecks q3hrs
- Report BSL >
- IDDM pts may need regular insulin q3hrs
- Eat jello, cream soup, custard, graham crackers 6-8 times/day
- Prevent dehydration by drinking ½ cup OJ, soda, broth, or 1 cup
Gatorade q30min
- Report extreme vomiting, diarrhea
- Type I may need hospitalization if unable to retain fluids Type 2 diabetes
- Clinical Manifestations o May have 3 P’s too o More common ▪ Fatigue ▪ Recurrent infections
Diagnostics for DM o A1C: 6.5% or higher o Fasting plasma glucose : 126 mg/dL or higher o 2-hr plasma glucose level: 200 mg/dL or higher
▪ Oral glucose tolerance testing is no longer recommended for routine clinical use. Tests to distinguish Type 1 vs 2 o Presence of endogenous insulin = Type 2 ▪ Endogenous insulin is absent in Type 1 o Islet cell antibody testing ▪ Positive = Type 1 Teaching for Diabetic Pts
- Nutritional therapy
- Drug therapy
- Exercise o Lowers BSL by increasing uptake of glucose by muscles o Improves circulation & muscle tone, facilitates wt loss o Pts with uroketones should NOT exercise ▪ If BSL > 250, no exercise if ketones present o 150 min/wk of moderate aerobic activity o Concern: hypoglycemia ▪ Do accuchecks before, during, & after ▪ If BSL < 100, eat 10-15 g carb and recheck in 15-30 min o Wait to exercise 1 hr post meal
- Self-monitoring of blood glucose o Self-monitoring of Blood Glucose o Do comparison of results with lab every 6-12 months o 2-4 times/day o Need to keep a log o Puncture on side of finger o Urine : check ketones for type 1, during sickness & pregnancy o Type 1 diabetes ▪ Often test their blood glucose before meals. ▪ Checking blood glucose 2hrs after the first bite of food determine if the bolus dose was adequate o During illness: check blood glucose levels at 4-hour intervals - Diet, exercise, and weight loss may be sufficient for Type 2
- Decrease o Lipid levels o Calories & fat to have normal glucose, lipid, & B/P levels ▪ Even a 10% weight reduction can cause large improvements in glucose levels
- Alcohol : Main danger is hypoglycemia
- Insulin to carb ratio: 1 units: 6 gm carbs
▪ Repeat BS in 15 min, if still low/symptomatic repeat. If BS rising, give meal within hour o If patient not alert: give IM glucagon or 20-50 ml D50 IVP, recheck BS and monitor: follow with meal once alert ▪ Nausea is a common reaction after glucagon injection. ▪ To prevent aspiration turn the patient on the side until he or she becomes alert o Follow the “Rule of 15” to treat hypoglycemia. ▪ 15g carbs ▪ Check after 15 min ▪ Still less than 70 15g more carbs Diabetes insipidus
- Differences from diabetes mellitus and Management – F&E risks
- Your body can't properly balance fluid levels - Characterized by large amounts of dilute urine and increased thirst. o Amount urine produced can be ~ 20 liters per day.
- Complications may include dehydration or seizures.
- Fluid imbalance makes you very thirsty even if you've had something to drink.
- Can be caused by damage to hormone secreting organs, genetics, or medications Vascular disorders module (2 parts) Webex Notes
- Aneurysms - how to prevent it o Surgery- what are potential complications and how to prevent them, what should we monitor? - PAD vs CVI o PAD = Arterial - worried about pulses and oxygenated blood getting to tissues. o CVI = Venous – worried about backup of fluid
- DVT and PAD o Know differences between antiplatelets (aspirin, Clopidogrel) & anticoagulants (warfarin) o what should we teach pts, whats the risk, how do we manage it? Venous- worried about backup of fluid
- Pulses, edema, dull aches or no pain, skin assess - Effects on system o hypercoagulability of blood, arterial fibrillation, immobility, HF, pregnancy, stroke, obesity
- Diagnostic - lab tests, venous compression ultrasound, duplex ultrasound, CTV Arterial- worried about pulses and oxygenated blood getting to tissues.
- Ischemia, pulses, skin, temp, color - Effects on system o Smoking, diabetes, elevated lipid levels and cholesterol, high BP
- Diagnostic segmental bp, ABI, MRA, angiograft, chest x-ray, echocardiogram Hypertension Lewis Tables 32.2, 32.3, 32.4, 32.5, 32.6, 32.7, 32.
