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exam 4 med surg
Primary Angle-Closure Glaucoma (PACG - Acute)
Mechanism
Rapid Increase in IOP
Signs and Symptoms
Rapid Onset
Pain
Blurred Vision
Halos Around Lights
Nausea and Vomiting
IOP over 30 mm Hg
Considerations
Drug Therapy
Surgery
1 min
Primary Open-Angle Glaucoma (POAG - Chronic)
Mechanism
Flow of Aqueous Humor Slowed
Signs and Symptoms
Slow Onset
No Pain
Tunnel Vision
IOP 22-32mm Hg
Considerations
Drug Therapy
1 min
Age-Related Macular Degeneration (AMD)
Mechanism
Dry (nonexudative)
Wet (exudative)
Signs and Symptoms
Scotomas
Blurred, Darkened Vision
Loss of Central Vision
Distortion of Vision
Considerations
Drug Therapy
Surgery
Low-vision Assistive Devices
2 mins
Cataract
Mechanism
Age-related
Assessment
No Pain
Cloudy Opaque Lens
Decreased Visual Acuity
Occurs Gradually
Treatment
Surgery
1 min
Causes of Vertigo
Meniere's Disease
Increased endolymph in inner ear
Recurrent vertigo
Head fullness/ear pain
Hearing loss and tinnitus
Benign Paroxysmal Positional Vertigo (BPPV)
Otoliths in semicircular canals
Episodes brought on by head movement
Normal hearing/no auditory symptoms
Vestibular Neuritis
Viral/Postviral
Single episode, can last days
No hearing loss
Peripheral Vertigo
Peripheral Vertigo happens at Vestibular Nerve (CN 8) and Vestibular Apparatus (Ex: Cochlea)
Meniere's Disease
Excess endolymph (less reabsorption)
Neurofibromatosis Type 2 cause acoustic neuromas on both Vestibulocochlear nerves at Cerebellopontine angle
Schwannoma of CN 8 (arise from Schwann Cells)
Caused: Respiration infection by a Virus
Vestibular neuritis (inflammation CN 8)
Nystagmus is Never Vertical (horizontal and torsional only)
Clinical: hearing loss, tinnitus
Benign paroxysmal positional vertigo
1 min
Meniere's Disease
Mechanism
Excess Endolymph
Signs and Symptoms
Tinnitus
One-sided Sensorineural Hearing Loss
Vertigo
Nausea and Vomiting
Considerations
Meclizine (Antivert)
Low Salt Diet
Surgery
2 mins
Otitis Media Assessment
Red or Bulging Tympanic Membrane
Ear Pain
Pulling at Ear
Fever
Upper Respiratory Infection
Considerations
More Common in Young Children
Eustachian Tube Narrower
Conductive Hearing Loss
Smoking Increases Risk
2 mins
Ear Pathologies
Cholesteatoma
Pearly mass behind tympanic membrane
Primary: Due to constant negative pressure in middle ear
Secondary: Due to squamous epithelial migration
Squamous cell debris
Painless otorrhea
Conductive hearing loss
Cholesterol Granuloma
Can form in middle ear after hemorrhage
Bluish-black material behind tympanic membrane
Squamous Cell Carcinoma
Most common malignancy of middle ear
Ulcerated plaque/nodule
Presents with regional pain
Granulomatous disease of ear
Uncommon, usually secondary to systemic disease
Care for the Visually Impaired
Assessment
Decreased Visual Acuity
Snellen Chart
Status of Corrective Lenses
Nursing Considerations
Sighted-Guide Technique
Communication
Safe Environment
Medications
Clock Technique for Food
Activities of Daily Living (ADL)
1 min
Otitis Media Interventions
Antipyretics
Analgesics
Antibiotics
Irrigation
Position on Affected Side
Myringotomy
Tympanostomy Tube
2 mins
Ear Drops Medication Administration
Indications
Earwax Buildup
Ear Infections
Pulling The Pinna
Child - Back and Downward
Adult - Back and Upward
Procedure
Side-Lying with Ear Up
Instill Medication
Stay for 2-3 Minutes
Nursing Considerations
Room Temperature
May Massage Tragus
Perforated Eardrum
2 mins
Eye Medication Administration
Procedure
Supine with Neck Hyperextended
Wash Away Crusts
Cotton Ball on Cheekbone
For Ophthalmic Drops
Instill Drops into Conjunctival Sac
Repeat if Missed or Patient Blinks
5 Minutes Before 2nd Medication
For Ophthalmic Ointment
Thin Stream Along Inner Edge
Inner Canthus to Outer Canthus
2 mins
Care for the Hard of Hearing
Assessment
Normal: 0-15 dB
Rinne's Test
Weber's Test
Tinnitus
Difficulty Following Conversations
Nursing Considerations
Face Patient/Speak Clearly
Rephrase Misunderstood Statements
Repeat Statements Back
Hearing Aids
Sign Language
2 mins
Androgen Antagonists
Finasteride
5-Alpha Reductase Type II Inhibitor
indicated for BPH, Alopecia
Flutamide
Non-steroidal Competitive AR Antagonist
indicated for Metastatic Prostate CA
give with Leuprolide
SFx: Teratogen
Ketoconazole
Spironolactone
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