Term
|
Definition
excision or removal of
ex. Appendectomy |
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
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Term
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Definition
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Term
|
Definition
| cutting into or incision of |
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Term
|
Definition
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Term
| what 3 aspects must an informed consent outline about surgery? |
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Definition
| benefits, risks, and alternatives |
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Term
|
Definition
| which family member or court appointed person will speak for you when you cant |
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Term
in preoperative testing why are these tests done?
EKG
CBC
Electrolytes
PT/PTT
Blood Type
Chest X-ray
serum glucose
UA
BUN/Creatinine
PFT |
|
Definition
EKG- rate and rhythm of heart
CBC- check to see if anemia or have infection
Electrolytes- assess electrolyte levels that affect the heart
PT/PTT- check cogalation level
Blood Type- A B or O if transfusion might be needed
Chest X-ray- check for enlarged heart and for pneumonia
serum glucose- check for elevated BS
UA- check for infection
BUN/Creatinine- assess renal function
PFT- check expansion and tidal volume |
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Term
|
Definition
prothrombin time: used to monitor effects of Coumadin therapy.
ideal: 12-15 sec |
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Term
|
Definition
International Normalized Ratio: used in conjunction with PT to assess effects of Coumadin. Ideal: 0.8-1
Ideal for those on Coumadin: 2-3 |
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Term
Describe these values:
INR: 5
INR: 0.5 |
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Definition
INR=5: High chance of bleedings
INR=0.5: High chance of clotting |
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Term
|
Definition
| Partial Thromboplastin Time: used to monitor heparin therapy. Should be 30-40 sec |
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Term
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Definition
| it depletes Vitamin K which is needed in the clotting cascade, so it prolongs clotting |
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Term
| a deficiency in what will delay the INR? |
|
Definition
Vitamin K
(Coumadin depletes Vitamin K to delay the INR, take it longer to clot) |
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Term
| to administer lovenox what should you check? |
|
Definition
| CBC for Hgb and Hct to make sure they are not anemic, and there platelets to assess their clotting ability |
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Term
| why would you not give lovenox to a presurgical patient? what is the timeframe to NOT give it? |
|
Definition
Because lovenox can NOT be measured once it is in the blood, nor can it be revered.
Do NOT give to a patient who is having surgery/invasive procedure within the next 12-24 hours |
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Term
| describe the flow of the patient during a surgery: |
|
Definition
| preadmission testing TO preop holding unit TO OR to PACU to Med/Surg or ICU |
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Term
What is infiltration?
Nursing Process?
Need new orders or call MD? |
|
Definition
is when the IV catheter becomes either partially or completely discharged from a vein and IV fluid leaks into surrounding tissue
Assessment: area will be puffy and swollen,will be painful and cold
Interventions/Treatment: Stop the infiltration, DC the IV, and start a new one
do NOT need to obtain order or call MD |
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Term
What is phlebitis?
Nursing Process?
Need to call MD or need new order? |
|
Definition
Is irritation of the vein
Assessment: erythema (redness) and pain along path of the vein and cording (becomes hard)
Intervention (Treatment): stop the infusion of IV fluids, DC the IV, notify the MD, administer antibiotics, obtain order to start new IV in a new site. |
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Term
|
Definition
| fluid damage to tissue that leads to necrosis of the tissue |
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Term
when a patient has decreased renal function what can there be an accumulation of (post-op) due to lack of excretion?
who is at risk?
what labs should you check? |
|
Definition
lack of excretion of:
wastes, medications, and anesthetics
at risk:
elderly, chronic renal failure, acute renal failure, and DM
Labs:
creatinine and BUN |
|
|
Term
| why is checking hepatic function prior to surgery so important? what labs can be used to assess this? |
|
Definition
| because some anesthetic agents are excreted by the liver. AST, and ALT |
|
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Term
| acute, viral, or alcoholic hepatitis, and cirrhosis, are all |
|
Definition
| reasons to postpone elective surgery |
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Term
| why is it important to establish a neurological baseline prior to surgery? |
|
Definition
| so that any problems that were already there are not thought the be a perioperative event. |
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Term
| what are some neurological perioperative complications? |
|
Definition
perioperative stroke
delirium
dementia |
|
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Term
| what medications affect the hematology of a preoperative patient? |
|
Definition
anticoagulants (warfarin, heparin, and lovenox) thin the blood
NSAIDs (motrin,advil, and ibuprofen) affect platelet clotting for 48 hours
ASA (aspirin) affects platelet clotting for 7 days, so ask patient to stop taking ASA a week before surgery
TCA
Alcohol
Beta-blockers |
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Term
| who is at risk for endocrine impairment? |
|
Definition
| elderly, obese, diabetics |
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Term
| those with endocrine function impairments are at risk for |
|
Definition
| postoperative wound infections and delayed wound healing |
|
|
Term
| patients with diabetes also have a decreased immune function which can lead to |
|
Definition
| delayed wound healing and wound infection |
|
|
Term
| long term steroid use can cause what to immunity? |
|
Definition
|
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Term
| a patient deficient in vitamin B12 and iron can become |
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Definition
|
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Term
| if a patient is on Coumadin therapy, what vitamin should you NOT give them? What foods contain this? |
|
Definition
| Vitamin K, like leafy green vegetables should not be given |
|
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Term
| what types of foods would provide patient with Vitamin C? |
|
Definition
| citrus, tomatoes, strawberries, and broccoli |
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Term
| what types of food would provide folic acid? |
|
Definition
| milk, cheese, meat, fish, and poultry |
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|
Term
| what foods would give vitamin B12 |
|
Definition
| whole grains and leafy green vegetables |
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Term
| what foods would provide patient with iron? |
|
Definition
| lean meat, whole grains, and leafy green vegetable |
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Term
Drug Type: Anticoagulants
What are some examples of these?
What are there uses?
What are their side effects? |
|
Definition
Drug Type: Anticoagulants
What are some examples of these?
Lovenox, Heparin, and Coumadin
What are there uses?
Blood thinners
What are their side effects?
Bleeding |
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Term
Drug Type: NSAIDs
What are some examples of these?
What are there uses?
What are their side effects? |
|
Definition
Drug Type: NSAIDs
What are some examples of these?
Ibuprofen, Motrin, and Advil
What are there uses?
anti-inflammatory, analgesic, and antipyretic
What are their side effects?
increase bleeding risk, and they affect platelets for 48 hours |
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Term
Drug Type: Steroids
What are some examples of these?
What are there uses?
What are their side effects? |
|
Definition
Drug Type: Steroids
What are some examples of these? Solumedrol, Solucortef, and Prednisone
What are there uses? decrease inflammation
What are their side effects? increase: WBC, glucose, anxiety and restlessness, and delay wound healing |
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Term
Drug Type: Antihypertensives
What are some examples of these?
What are there uses?
What are their side effects? |
|
Definition
Drug Type: Antihypertensives
What are some examples of these? Lopressor (Metoprolol)
What are there uses? Prevent increase in BP
What are their side effects? Decrease BP |
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|
Term
Drug Type: Diuretics
What are some examples of these?
What are there uses?
What are their side effects? |
|
Definition
Drug Type: Diuretics
What are some examples of these? Lasix, Dermadex, and Bumex, and Hydrochlorothiazide
What are there uses? Decrease circulating blood volume
What are their side effects? decreased BP |
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|
Term
| Analgesics and antihistamines BOTH cause |
|
Definition
|
|
Term
| steroids can do what to immune function? |
|
Definition
|
|
Term
| analgesics, antihypertensives, antihistamines, and diuretics are usually given or helf before surgery? |
|
Definition
|
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Term
| in the preoperative patient you may need to do what to the insulin dose? |
|
Definition
|
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Term
|
Definition
runs grand scheme or OR
advocates for patient
ensures charting and communication
is NOT sterile person in sterile field |
|
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Term
|
Definition
STERILE person in sterile field
prepares instruments
assists surgeon
counts instruments and supplies at the end of surgery |
|
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Term
| once the drape is on the patient, where is sterility? |
|
Definition
| only the TOP is sterile, the bottom is NOT |
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Term
| if an unsterile person crosses a sterile field then |
|
Definition
|
|
Term
| sterile field is maintained by the |
|
Definition
| circulating nurse, but everyone is responsible |
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Term
| supine (dorsal recumbent) |
|
Definition
| facing up with back on table |
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Term
|
Definition
| facing down with face on table |
|
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Term
| what are the types of anethesia? |
|
Definition
1. general
2. regional
3. local
4. IV conscious sedation |
|
|
Term
| what methods of administration are used in general anesthesia? |
|
Definition
|
|
Term
| what are examples of regional anesthesia? |
|
Definition
| spinal, epidural, and nerve block |
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Term
| after a patient has received a spinal or epidural anesthesia and the needle is removed, the MD will order that the patient lie flat for 6-12 hours to prevent the |
|
Definition
| leakage of CSF and to prevent post spinal or post epidura; headaches |
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Term
|
Definition
| giving anesthesia in a small local area like sewing a thumb |
|
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Term
|
Definition
| patient is sleepy, still conscious, and will not remeber |
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|
Term
some examples of narcotic opioids:
what are they used for? |
|
Definition
Meperidine (Demerol)
Fentanyl (Sublimaze)
Morphine Sulfate |
|
|
Term
what kind of drug is fentanyl?
what is so unique about it? |
|
Definition
| Fentanyl is an opioid analgesic that causes NO nausea and vomiting and has fewer allergic reactions |
|
|
Term
What are benzodiazepines used for?
What are some examples? |
|
Definition
CNS depression
Midazelam (Versed)-produces amnesia
Diazepam-Valium |
|
|
Term
|
Definition
| is Versed and it induces amnesia |
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|
Term
| to reverse respiratory depression caused by narcotics you can give __________________________________________ but it must by given _______________ SLOWLY to prevent____________________________ |
|
Definition
to reverse respiratory depression caused by narcotics you can give Naloxone (Narcan) but it must by given IV push
SLOWLY to prevent seizures |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Benzodiazepine antagonist |
|
Definition
|
|
Term
|
Definition
| Romazicon: benzodiazepine antagonist |
|
|
Term
|
Definition
| Compazine, Zofran, and Phenergen |
|
|
Term
| why would hyPOtension be induced operatively? |
|
Definition
| to control bleeding at the operative site |
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|
Term
| a low fluid volume in the body could lead to |
|
Definition
|
|
Term
what are some of the causes of inadvertant hyPOthermia?
what are some nursing interventions? |
|
Definition
cold OR room, cold IV fluids, open incision, age, cold gas inhalation, and drugs
NI: cover with warm blanket, change wet gowns, give warm I fluids |
|
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Term
|
Definition
| most severe type of allergic reaction that can cause cardiac or respiratory arrest |
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|
Term
What is malignant hyperthermia?
What are the early findings?
What are the late findings?
What are your nursing interventions? |
|
Definition
MH: a genetic predisposition that causes an increase in metabolic rate leadings to hyperthermia, can be lethal
Early: unexplained venricular dysrhythmias, tachycardia, premature ventricular contractions, jaw spasms, tachpnea, cyanosis, skin mottling, and unstable BP
Late: elevation in temperature, hypercalcemia, herkalemia, hypermagnesia, renal failure, and pulmonary embolism
will also see shivering and muscle contraction
NI: ADMINISTER DANTROLENE STAT |
|
|
Term
| what is the ideal urine output? |
|
Definition
|
|
Term
| in terms of older patients, what must be taken into consideration in regards to drugs? |
|
Definition
1. they often need less
2. takes longer from them to metabolize and excrete them |
|
|
Term
are older adults more at risk for hyPERthermia or hyPOthermia?
what can be done? |
|
Definition
| hyPOthermia; keep them warm with blankets and dry gowns, etc |
|
|
Term
| what is PACU? and when does the patient go there? |
|
Definition
| post-anesthesia care unit, after the OR |
|
|
Term
| in PACU should 2 rails be put up? |
|
Definition
|
|
Term
| what are the benefits of PACU? |
|
Definition
1. very close to OR and MD's for reevaluation ans assessment
2. small nurse to patient ratio for closer observation |
|
|
Term
| when a patient coming from the OR into PACU, your first action after checking ID is to |
|
Definition
| ensure the patient's airway is NOT obstructeed by the tongue or anything else. So patient should not be lying flat on their back |
|
|
Term
| a patient from the OR who is new to PACU may have lost ALOT of fluid, blood, and electrolytes during surgery. This is why it is important to monitor I and O in PACU. However, overhydration may lead to |
|
Definition
| fluid or crackles in the lungs |
|
|
Term
| in PACU what time frame is most important for monitoring I and Os? How often should you monitor? When should they return to normal? What is the ideal urine output? |
|
Definition
in PACU what time frame is most
important for monitoring I and Os" First 24-48 hours
How often should you monitor? Every 2-4 hours
When should they return to normal? After 48 hours
What is the ideal urine output? 30 ml/hr |
|
|
Term
| to prevent aspiration in a PACU patient, at what 3 positions can the patient be left in? |
|
Definition
| side lying, semi Fowler's and high Fowler's |
|
|
Term
| when is a patient transferred from PACU to ICU or Med Surg? |
|
Definition
| When vitals are stable and patient is alert and oreinted |
|
|
Term
| if you have a patient in PACU with less than 30 ml/hr what should you do? |
|
Definition
1. notify MD to avoid acute renal failure
2. give IV fluids |
|
|
Term
| what are the common respiratory POSToperative complications? |
|
Definition
| pneumonia, atelectasis, and hypoxemia |
|
|
Term
Condition: Pneumonia
Assessment:
How is it diagnosed (by MD)?
Give an example of a nursing diagnosis
Goal:
Interventions/Treatment: |
|
Definition
Condition: Pneumonia
Assessment: productive cough, marked temperature increase, increased pulse and respirations, chest discomfort from cough
Diagnosed: Chest x-ray or sputum culture
Nursing Diagnosis: Impaired gas exhange r/t fluid accumulation at the alveolar/capillary membrane
Goals: To maintain adequate gas exchange and removal of excess fluid and exudate
Interventions/Treatment:
1. turn patient every 2 hours in a different position to prevent pooling of fluids and aspiration
2. keep hydrated, can be through IV fluids (unless CHF)
3. antibiotics
4. encourage ambulation or chair sitting
5. encourage deep breathing and chest expansion |
|
|
Term
Condition: Hypoxemia
Assessment:
Goal:
Interventions/Treatment:
Risks? |
|
Definition
Condition: Hypoxemia
Assessment: decreased O2 saturation, may be asymptomatic
Goal: demonstrate improved ventilation and adequate oxygenation
Interventions/Treatment:
1. administer oxygen
2. check for patent airway
3. place in semi-hi Fowler's
4. monitor vitals and rate, depth, and ease of respiration
Risks:
myocardial and cerebral ischemia and cardiac arrest |
|
|
Term
Condition: Atelectasis
Assessment:
Goal:
Prevention/Interventions/Treatment: |
|
Definition
Condition: Atelectasis
Assessment: decreased breathing sounds, dyspnea, coughing, anxious, cyanosis, and decreased O2 saturation
Goal: demonstrate improved ventilation and adequate oxygenation
Prevention/Interventions/Treatment:
1. administer humidified oxygen
2. deep breathing and coughing
3. place in semi-hi Fowler's
4. reposition patient often
4. encourage early mobilization |
|
|
Term
Condition: Shock
Assessment:
Goal:
Interventions/Treatment: |
|
Definition
Condition: Shock- when the patient has an overwhelming infection or low BP
Assessment: pallor, cool moist skin, rapid respirations, rapid pulse that is weak and thready, cyanosis (gums, lips, and tongue), decreased pulse pressure (normal=40), and concentrated and decreased urine output
Goal: client will maintain a systolic blood pressure greater than 90 or will maintain a urine output greater than 30 ml/hr
Interventions/Treatment:
1. call MD
2. administer fluids as ordered to restore fluid volume
3. keep patient warm
4. give O2
5. give Vasopressors to increase BP
6. may place in Trandelenburg |
|
|
Term
Condition: Hemorrhage
Assessment:
Prevention:
Goal:
Interventions/Treatment: |
|
Definition
Condition: Hemorrhage
Assessment: S/S of shock, decreased H and H, profuse wound drainage, increased tube drainage, swelling and pain at incision site
Prevention:NOT giving anticoagulants before surgery, checking H and H, monitor tubes and drains, and incision
Goal: prevent hypovolemia and excessive blood loss
Interventions/Treatment:
1. call MD
2. prepare for OR
3. replace fluids IV as ordered
4. apply pressure to incision site |
|
|
Term
Condition: DVT
Assessment:
Prevention:
Goal:
Interventions/Treatment: |
|
Definition
Condition: DVT
Assessment: + Howman's sign, pain and swelling, and calf is red and hard
Prevention: TEDS, SCDs, walking, calf pumps, antiocoagulants (Lovenox, not Coumadin because it takes 3 days)
Goal: prevent pulmonary embolism
Interventions/Treatment:
1. DO NOT walk, massage or rub area!
2. DO NOT walk!
3. Do give thrombolytic therapy: Lovenox or Heparin |
|
|
Term
Condition: Pulmonary Embolism (PE)
Assessment:
Diagnosis:
Goal:
Prevention:
Interventions/Treatment: |
|
Definition
Condition: Pulmonary Embolism (PE)
Assessment: sharp stabbing chest pain, feeling of impending death or doom, tachycardia, tachypnea, palpitations, coughing, diaphoresis, dyspnea, possible hemopytsis, crackles or rubs on auscultation, and sudden death
Diagnosis: NOT with x-ray, with CAT scan or Ventilation Perfusion scan
Goal: prevent death and restore normal breathing
Prevention: walking, SCDs, TEDS, prevent a blood clot, calf pumps, anticoagulants
Interventions/Treatment:
1. give anticoagulants: Lovenox and heparin
2. oxygen
3. surgery- pulmonary thrombolectomy
4. thromobolytics: super clot busters
5. give pulmonary vasodilators likes aminophylline to allow blood to pass around clot |
|
|
Term
Condition: Wound dehiscense
Assessment:
Goal:
Prevention:
Interventions/Treatment: |
|
Definition
Condition: Wound dehiscense
Assessment: feels like something popped or gave way, excessive serosanguinous drainage and the separation of wound edges
Goal: protect incision from infection
Prevention: Teach patient about splinting, tell patient to avoid heavy lifting or coughing,
Interventions/Treatment:
1. cover with a dry aseptic dressing
2. lay down flat with knees flexed
3. call MD
4. give antibiotics |
|
|
Term
Condition: Evisceration
Assessment:
Goal:
Prevention:
Interventions/Treatment: |
|
Definition
Condition: Evisceration
Assessment: intestines have protruded from wound edges
Goal: protect intestines from necrosis and infection
Prevention: Teach patient about splinting, tell patient to avoid heavy lifting or coughing
Interventions/Treatment:
1. cover with a wet sterile dressing with normal saline
2. lay down flat
3. call MD and OR STAT
4. NPO because they are going to surgery
5. provide IV access and take VS
6. place bed in low Fowler's |
|
|
Term
Condition: Infection
Assessment:
Goal:
Prevention:
Interventions/Treatment: |
|
Definition
Condition: Infection
Assessment: increased temp, WBC, and pulse. Incision is swollen, red, tender, warm, with purulent drainage
Goal: treat infection and avoid further infection
Prevention: Hand washing, use of sterile technique when changing dressing, keeping it covered, educating client on prevention technique and S/S and prophylactic antibiotics
Interventions/Treatment:
1. Culture purulent drainage
2. MD
3. antibiotics |
|
|
Term
| In assessing patient's visual function what data should you collect? Both subjective and objective |
|
Definition
Subjective:
1. pain
2. past medical history (any DM or HTN)
3. medicines (herbs, conventional, dietary supplements)
4. health management (smoking, sun glasses, etc)
Objective:
1. appearance of eyes: (redness, swelling, edema)
2. photophobia
3. abnormal tearing
4. visual acuity (Snellen chart, 20 feet away)
5. PERRLA |
|
|
Term
| PERRLA: Explain each letter. |
|
Definition
Pupils
Equal
Round- if not round could be due to trauma or cataracts
Reactive to Light
and
Accommodating- ability for eyes to converge on the same object |
|
|
Term
| the most common cause of visual problems is |
|
Definition
|
|
Term
| Our eyes bend light rays and focus them through the lens and into a sharp image onto our __________________________________________ |
|
Definition
|
|
Term
| with refractive errors instead of the sharp image being focused through the lens and onto the retina, the light is bent either before or after the retina. What types of complaints will your patient make? |
|
Definition
headaches: due to eye straining
and blurred vision |
|
|
Term
Types of refractive error: (describe each)
1. Myopia
2. Hyperopia
3. Presbyopia
4. Astigmatism |
|
Definition
1. Myopia- near sightedness, you see things that are near the best
2. Hyperopia- far sightedness, who you see things that are far the best
3. Presbyopia- gradual aging that leads to hyperopia
4. Astigmatism - misshapen lens that leads to blurry vision |
|
|
Term
| what are the corrections to refractive errors? |
|
Definition
1. glasses
2. contact lenses
3. LASIK refractive surgery |
|
|
Term
| what refractive errors can NOT be corrected? |
|
Definition
| total and functional blindness |
|
|
Term
| to be legally blind what must your visual acuity be? |
|
Definition
|
|
Term
| what are the different types of eye trauma? |
|
Definition
1. blunt
2. penetrating
3. chemical
4. burn |
|
|
Term
-what is blunt force trauma to the eye?
-how is it diagnosed? by who? by what procedures?
-what are your main interventions? and medications? what type? |
|
Definition
-what is blunt force trauma to the eye?
when the eye is struck by a blunt force object
-how is it diagnosed? by who? by what procedures?
diagnosed by mechanism of injury (MOI).
diagnosed by MP or opthalmalogist
used x-ray to check for broken bones and CT scan to check for internal bleeding
-what are your main interventions? and medications? what type?
1. Check ABCs
2. Check LOC
3. Difference b/t good and bad eye
4. Visual acuity
5. keep sitting up to decrease ICP
6. apply ice
7. NO direct pressure
8. if ordered administer NON-opioid analgesics to avoid respiratory and LOC depression |
|
|
Term
-what is penetrating trauma to the eye?
-how is it diagnosed?
-what are your main interventions? and medications? what type? |
|
Definition
-what is penetrating trauma to the eye?
something has penetrated the eye
-how is it diagnosed?
by the mechanism of action (MOA) by MD or ophthalmologist
-what are your main interventions? and medications? what type?
1. ABCs
2. LOC
3. DO NOT PULL IT OUT
4. avoid patient from moving head to avoid lodging object in further
5. Sit or lay down sitting up to decrease ICP
6. If object is small place a bandage over both eyes to prevent good eye from straining |
|
|
Term
Chemical eye trauma:
-how is it diagnosed?
-what are your main interventions? and medications? what type? |
|
Definition
Chemical eye trauma:
-how is it diagnosed?
by mechanism of action (MOA_
-what are your main interventions? and medications? what type?
1. ABC (especially in inhaled)
2. identify substance
3. ASAP irrigate with 0.9% Normal Saline (NaCl) for 10-15 minutes to remove chemical and avoid further damage |
|
|
Term
Burn to eye
-what are your main interventions? and medications? what type? |
|
Definition
Burn to eye
-what are your main interventions? and medications? what type?
1. remove from burning site/object
2. ABCs
3. Get to MD STAT!
4. Types of burn:
- thermal: curling iron
-burn to retina: looking at sun
5. assist MD in comforting patient
6. administer eye drops like tetracaine which numbs eye to reduce pain |
|
|
Term
| what can antihistamines do to the eyes? |
|
Definition
|
|
Term
conjunctivitis-
what are the 4 types?
How are they treated? |
|
Definition
conjunctivitis-infection or inflammation of the conjuctivae (know as pink eye)
can be bacterial, viral, chlymadial, or allergic.
with bacterial: treat with antibiotics
with viral: antibiotics will NOT be effective, have to wait it out
with clymadial: refer to specialist
with allergic: ID allergen and avoid it, give antihistamine and corticosteroid drops (gtts) to decrease inflammation |
|
|
Term
|
Definition
is a sty
1. infected sebaceous gland
2. due to hygiene
3. use warm moist compresses
4. usually on lower margin
5. painful and tender
6. red, swollen, and circumscribed |
|
|
Term
|
Definition
| usually on the upper lid, due to an inflammed granuloma sebaceous gland, can be surgically removed, use warm and moist compresses |
|
|
Term
| why is it important to assess for decreasing visual acuity with patients with conjunctivitis? |
|
Definition
| because it should not cause decreasing VA, it may be due to an underlying cause |
|
|
Term
Eye Disorder: Cataracts
Causes:
S/S:
Treatment & Interventions: |
|
Definition
Eye Disorder: Cataracts
A clouding of the lens that leads to opacity which causes the blockage of light.
Causes:
1. Trauma
2. UV light
3. Diabetes
4. Corticosteroids
S/S:
1. Patient complains of blurry vision that is clouded
2. Pupils are irregularly shaped and hard to distinguish
3. Opaque lens
4. Age related
Treatment & Interventions:
1. Surgery: painless, takes 1 day for recovery
2. Palliative: if surgery is contraindicated; vision will continue to deteriorate |
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Term
| What should be done perioperatively for a patient undergoing cataract surgery? |
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Definition
Preoperatively:
1. ABCs and head to toe
2. NPO for 6-8 hours prior to prevent aspiration
3. Given sedatives
4. Prophylactic antibiotic and corticosteroid eye drops
Postoperatively:
1. protect eye from light
2. dilating eye drops: mydriatic and cycloplegic
3. will recieve NSAID eye drops
4. education: having a driver, and to report any pain because it can be do to hemorrhaging since cataract surgery is PAINLESS
5. avoid activities that increase IOP: bending coughing, and lifting |
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Term
| why should patients who have recently had cataract surgery avoid sunlight? |
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Definition
| because their eyes are dilated more than usual due to the mydriatic and cycloplegic eye drops |
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Term
Retinal detachment:
Causes:
S/S:
Interventions:
Treatment:
PostOp: |
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Definition
Retinal detachment: A break or tear in the retina causes aqueous humor to leak causing a buildup of pressure that leads to complete detachment.
Causes: trauma and cataract surgery
S/S:
1. photopsia: flashing lights
2. floater's ring
3. loss of central and peripheral vision
4. painless
5. ALERT MD ASAP!
Interventions:
1. Early detection
2. Encourage regular checkups
Treatment: Laser photocoagulation
PostOp:
1. Educate on importance of eye drops, pain meds and no activities that increase IOP and S/S |
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Term
Age Related Macular Degeneration (AMD)
S/S:
Types:
Diagnosis:
Recovery of vision?
Photodynamic therapy- |
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Definition
Age Related Macular Degeneration (AMD)
Is age related and occurs gradually
S/S:
complaints of blurry vision and decrease in central vision where they can't see their family's face or nose
Types:
Wet: when blood vessels leak, is sudden and damage is rapid
Dry: gradual, and may be unnoticeable
Diagnosis:
Done by opthamologist using tonometry with dilated pupils
Recovery of vision?
Patient will not recover lost vision but we can help enhance what vision they have left
Photodynamic therapy-
encourage to wear protective clothes to prevent sunburn from the receiving of dye that takes |
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Term
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Definition
| part of the eye that helps you see fine detail |
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Term
Glaucoma:
Criteria:
Types
Asses:s:
In both:
Open:
Closed:
Prevention:
At Risk:
What about the vision that was lost?
Specific Interventions:
Open Angle:
Closed Angle: |
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Definition
Glaucoma:
Criteria:
1. increasing IOP that is causing damage or injury to the optic nerve
2. decreasing peripheral vision
3. fluid balance issues
Types:
1. Open Angle: Slow onset that occurs gradually, painless, fluid drainage is clogged, most common
2. Closed Angle: Rapid, bulging lens, inhibition of fluid drainage, painful....Surgical emergency!
Assess:
In both: for decreasing peripheral vision
Open: Maybe gradual, might not even notice. Decreasing peripheral vision may lead to tunnel vision which may lead to blindness. Painless
Closed: Painful, sudden onset, fluid is unable to drain, N/V, blurry vision
Prevention:
1. Glaucoma IS PREVENTABLE!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
2. Patients 40 and 50 need regular checkups
At Risk:
1. African Americans
2. HTN
3. Obese
What about the vision that was lost?
Can NOT be reversed
Specific Interventions:
Open Angle:
1. Educate patient that they will be on eye drops long term and that we can protect the vision that is left and not regain that which was lost.
Closed Angle:
1. Surgical emergency: undergo Iridectomy
2. Will decrease IOP
3. Will be given miotics to constrict pupils
4. This is why it is always important to check a pts history: if they have had closed angle glaucoma they can NEVER be given mydriatics or cycloplegics or any medication that will dilate their pupils |
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Term
| how do you apply ophthalmic medications? |
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Definition
1. using aseptic technique (not sterile): wash hands and wear gloves
2. pull down on lower lid
3. place medication on lower conjuctiva
4. block the inner canthus to avoid systemic absorption |
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Term
medications that cause dilation are:
what are the precautions? |
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Definition
cycloplegics and mydriatics cause DILATION of the pupils
Precautions: pt must protect their eyes from sunlight and bright lights so wear sunglasses |
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Term
what are the medications that cause constriction?
Precautions? |
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Definition
Cholinergics and miotics cause CONSTRICTION of pupils
Precautions: Because they cant see in dim or low light, they must avoid injury |
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Term
| what is the problem with a patient who has glaucoma and also a cardiac patient on beta blockers? |
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Definition
| patient may be ordered topical beta blockers to decrease IOP and reduce fluid in eye, and if they are also on systemic beta blockers you can accidentally double their dose and drop their HR to much. So check!!! |
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Term
| what pupil dilators are given before surgery? |
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Definition
| the mydriatics and cycloplegics given before are atropine and cyclogy |
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Term
| what pupil constricts are given for the prevention of blindness and treatment of glaucoma? |
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Definition
| the miotics are cosopt and xalantan |
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Term
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Definition
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Term
| Corticosteroids drops are given |
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Definition
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Term
In your assessment you check for: visual acuity and opaqueness of lens
What disorder do you suspect/ are looking for? |
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Definition
In your assessment you check for: visual acuity and opaqueness of lens
What disorder do you suspect/ are looking for? looking for decreasing visual acuity to indicate cataracts |
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Term
In your assessment you check for: blurred vision and decreasing central vision
What disorder do you suspect/ are looking for? |
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Definition
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Term
In your assessment you check for: decreased peripheral vision and painless with slow onset
What disorder do you suspect/ are looking for? |
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Definition
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Term
In your assessment you check for: decreasing peripheral vision, painful and sudden
What disorder do you suspect/ are looking for? |
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Definition
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Term
In your assessment you check for: photopsia, floater's ring, painless, decreased central and peripheral vision
What disorder do you suspect/ are looking for? |
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Definition
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Term
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Definition
| Diabetes Mellitus is a metabolic disorder where the patient has a high blood sugar. Due to an absence or inadequacy of insulin production, or insulin insensitivity |
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Term
| what is the only hormone that lower blood sugar? |
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Definition
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Term
| what are the early symptoms of DM? What are the late? |
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Definition
Early: polyphagia, polyuria, polydipsia, blurry vision, fatigue, infection, weight loss and poor wound healing
Late: coma, and chronic complications |
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Term
| what are 3 tests that can be used to diagnose DM? |
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Definition
1. Fasting plasma glucose (no caloric intake for 8 hours): >126 mg/dl
2. Classic symptoms of DM and Casual plasma glucose (no regard to meals or time when eaten): >200 mg/dl
3. OGTT after 2 hours: >200 mg/dl |
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Term
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Definition
-pancreas secretes NO insulin
-insulin dependent diabetes who NEED insulin to avoid DKA or death
-weak family history
-+ for islet antibodies
-usually lean, under 30 and white
-rapid clinical presentation
-treatment: insulin, diet, exercise |
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Term
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Definition
-pancreas insulin secretion is impaired or inadequate
-insulin non dependent diabetes
-strong family history
-usually heavy, over 40, and African America
-slow clinical presentation
-treatment: diet and exercise, may need insulin with poor management |
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Term
| do to improper management, type 2 DM can lead to |
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Definition
| total pancreas shut down, leading to insulin dependent diabetes |
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Term
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Definition
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Term
| Type 2 DM can be managed with |
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Definition
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Term
| what are the complications of chronic hyperglycemia? |
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Definition
| retionopathy, peripheral neuropathy, cardiomyopathy, and nephropathy |
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Term
| at what blood sugar level is there hyperglycemia in type 1 and 2 diabetics? |
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Definition
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Term
| at what blood sugar is there a risk for DKA in type 1 DM and HHNS in type 2 DM? |
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Definition
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Term
Diabetic Complication:Retinopathy
Early detection:
Early intervention: |
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Definition
Diabetic Complication:
Early detection:dilated Funduscopic exam
Early intervention: See opthamalogist and control HTN and hyperglycemia |
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Term
Diabetic Complication: Nephropathy
Early detection:
Early intervention: |
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Definition
Diabetic Complication: Nephropathy
Early detection: Urine exam for albumin and protein excretion, also look at creatinine clearance and serum creatinine
Early intervention: control HTN, hyperglycemia, and other cardiovascular risk factors. Also decrease protein intake and avoid nephrotoxic agents |
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Term
Diabetic Complication:Atherosclerosis
Early detection:
Early intervention: |
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Definition
Diabetic Complication:Atherosclerosis
Early detection: History of risk factors and ECG, serum lipids, and peripheral pulses
Early intervention: control HTN, hyperglycemia, lipids, weight control, and exercise |
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Term
Diabetic Complication:Neuropathy
Early detection:
Early intervention: |
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Definition
Diabetic Complication:Neuropathy
Early detection:History of pain and numbness.
Exam: orthostatic blood pressures
also muscle strength, reflexes and sensory function
Early intervention:avoid neurotoxic agents, educate on importance of foot care, and control hyperglycemia |
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Term
| what is the primary goal in diabetes management? |
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Definition
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Term
| what are the ideal prandial goals for glucose? |
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Definition
pre-prandial: <110
post-prandial: MAX is 180 or lower |
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Term
| can the Hgb A1C be used to determine the effectiveness of a short term therapy? |
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Definition
| NO, tells the average blood glucose for the past 120 days or 3 months |
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Term
Weighted average blood glucose levels for HgbA1C of:
1. 6%
2. 8%
3. 10% |
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Definition
1. 6%- BS=135
2. 8%- BS=205
3. 10%-BS=275 |
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Term
| what is the triad for managing DM? |
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Definition
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Term
T or F:
A handheld glucometer can be used for the diagnosis of diabetes mellitus? |
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Definition
| FALSE: can only be used for management |
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Term
| diagnosis of diabetes must be made using |
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Definition
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Term
| what is the time frame used to test blood glucose before meals or bedtime? |
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Definition
| at least one hour before each |
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Term
| If you have a blood glucose reading of 200 at 0800 and it is now 1100 can you administer insulin according to the sliding scale? |
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Definition
| No, because the glucose reading is 3 hours old. ALL glucose readings must be within the hour in order to use it to perform medication or management. Get a new reading. |
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Term
| when performing a glucose check in the morning what is the time frame? |
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Definition
| for a fasting plasma glucose, it must be done within the hour. |
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Term
| when checking for nocturnal hypoglycemia at what time should you do a blood glucose check? |
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Definition
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Term
| if the blood glucometer reads "HI" or "400" for the glucose level what should you do? |
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Definition
| obtain a lab glucose STAT |
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Term
| what are some reasons that you would increase your monitoring of a patient's blood glucose? |
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Definition
| tube feeding, TPN, insulin drips, change in pts status, and NPO |
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Term
| what are the S/S of hypoglycemia? |
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Definition
convulsion
coma
confusion
diaphoresis
diplopia (double vision)
fatigue
hunger
headache
irritability
incoherent
pallor
tachycardia
weakness |
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Term
| the ideal BS should be over |
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Definition
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Term
treatment for hypoglycemia:
Conscious patient:
Unconcious with IV access:
Unconscious without IV access: |
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Definition
Conscious patient:give 15 grams of a simple carbohydrate. Give one of the treatments to not cause overtreatment:
-4 oz pure fruit juice (do NOT add sugar)
-4 oz carbonated soda (NOT diet)
-1/2 cup Jello (not sugar free)
-8 oz LOW fat milk
-3 pieces of hard candy
-3 glucose tablets
-2 or 3 honey/ jelly packets
Unconcious with IV access:
Unconscious without IV access: |
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Term
| in terms of giving a pt carbohydrates to increase the BS of a hypoglycemic patient, is it best to give a solid feeding that is high in protein and fat? |
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Definition
| no, it will take longer to absorb. it is best to give a small, concentrated and liquid form a carbohydrate |
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Term
Hyperglycemia:
What happens if it goes untreated?
Type 1:
Type 2: |
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Definition
Hyperglycemia:
What happens if it goes untreated?
Type 1: Diabetic Ketoacidosis (DKA)
-BS: 500-700
-Causes: infection that unstabilizes BS, trauma, surgery, MI, meds, inadequate insulin, and severe stress
S/S:
- dehydration
- loose skin turgor
- orthostatic hypotension
- tachycardia
- acetone breath
- Kussmaul's respirations
- polydipsia
- skin is warm, dry, and flushed
- N/V
Treatment:
1. Fluid resuscitation to dilute the BS
2. Decrease BS with a regular insulin IV bolus drip. Decrease BS SLOWLY! Only 50-70 mg/dl/hr
3. Start insulin slow drip once they are no longer ketotic
Type 2: Hyperglycemic Hyperosmolic Nonketotic Syndrome (HHNS)
-BS: 500-700
-Causes: Infection, GI bleeds, dialysis, burns, cardiac/renal problems, and loss of thirst.
Treatments: Similiar to DKA |
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Term
Compare DKA and HHNS:
Ages:
Symptom Duration:
Plasma Glucose Level: |
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Definition
Ages:
DKA: >40
HHNS: >60
Symptom Duration:
DKA: > 2days
HHNS: > 5 days
Plasma Glucose Level:
DKA: 250-800
HHNS: >600 |
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Term
What is Dawn Phenomenon?
S/S?
Treatment?
What is the Somogyi effect?
S/S?
Treatment?
What do they both have in common? |
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Definition
What is Dawn Phenomenon: There is a steady rise in hormones that causes an increase in glucose
S/S: High AM glucose level
Treatment? Give more insulin to combat hyperglycemia. Give intermediate or long acting insulin.
What is the Somogyi effect? Hypoglycemia is followed by a hyperglycemic rebound
S/S: Nightsweats, nightmares, AM headaches, high AM glucose
Treatment: Give less insulin to combat hypoglycemic event.
What do they both have in common? |
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Term
| what should you educate diabetic patients on in regards to alcohol consumption? |
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Definition
| that when alcohol is consumed the liver's priority is to metabolize the alcohol and glucose output is stopped which can lead to a fatal hypoglycemic event |
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Term
| what are the benefits of exercise? what should you educate your diabetic patient on in regards to exercise? |
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Definition
exercise increases insulin sensitivity, helps weight loss, can decrease medicine use by 25%, helps in energy (glucose) expenditure, decreases glucose level during and after, improves lipid profile, and promotes cardiovascular fitness.
Diabetics need to check BS before, during, and after exercise |
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Term
| is it true that only foods that are carbohydrates turn into sugar? |
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Definition
| FALSE: ALL foods turn into sugar |
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Term
| what is the importance of insulin? |
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Definition
| it is like the key that allows glucose to enter the body cells |
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Term
| what is the preferred site for insulin injection? |
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Definition
| abdomen because arms and legs get warmed during activity and may increase absorption |
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Term
| to avoid insulin dosage errors, what must be done before administration of insulin? |
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Definition
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Term
| describe the technique for drawing insulin, first using clear vs cloudy, then using short acting vs long acting |
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Definition
air into cloudy, air into clear, pull clear, pull cloudy
air into long, air into short, pull short, pull long |
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Term
| why is it important to ask a patient who is about to recieve insulin if they have any allergies? what specific allergy is important? |
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Definition
| ask for a sulfa allergy since NPH intermediate insulin has protamine sulfate |
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Term
| why is it important to pull up short acting and then long acting? |
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Definition
| because it could be fatal to get long acting insulin into the the short acting insulin. in an emergency where short or rapid acting insulin is needed and administered, if it has long acting insulin in it as well, the insulin will take longer to work causing life threatning consequences |
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Term
Type of Insulin: Rapid acting(Fast)
Names:
O:
P:
D:
Color: |
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Definition
Type of Insulin: Rapid acting (Fast)
Names: Humalog, Novalog, and Apidra
O: 15-30 minutes
P: 1-1.5 hours
D: 3-4 hours
Color: Clear |
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Term
Type of Insulin: Short acting
O:
P:
D:
Color: |
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Definition
Type of Insulin:Short acting
O: 0.5-1 hour
P: 2-3 hrs
D: 3-6 hrs
Color: clear |
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Term
Type of Insulin: NPH
O:
P:
D:
Color: |
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Definition
Type of Insulin: NPH (Intermediate)
O: 2-4 hrs
P: 4-10 hrs
D: 10-16 hrs
Color: cloudy |
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Term
Type of Insulin: Long acting
Names:
O:
P:
D:
Color: |
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Definition
Type of Insulin: Long acting
Name: Levemir
O:3-4
P: 6-8
D: 12-30
Color: clear
Name: Lantus *ideal for TPN use because lack of peak
O: 1-4
P: None
D: 10.8-24+ hrs
Color: Clear |
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Term
| what is the ONLY cloudy insulin? |
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Definition
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Term
| what is the insulin that is ideal for use with TPN? Why? |
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Definition
| Lantus because it has no peak, therefore will not cause a hypoglycemic event |
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Term
| what type of insulin is used for surgery, DKA, and HHNS? |
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Definition
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Term
| in pre-mixed insulins, what is the trick to knowing the content? |
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Definition
| the longer acting one (usually in NPH intermediate) comes first. |
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Term
| tell the components of the following mixed insulin: Humulin/Novolin 70/30 |
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Definition
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Term
| tell the components of the following mixed insulin: Novolog Mix |
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Definition
| 70% Novolog buffered 30% Regular |
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Term
| tell the components of the following mixed insulin: Humulog 75/25 |
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Definition
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Term
| tell the components of the following mixed insulin: Humulin 50/50 |
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Definition
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Term
| What are the types of antihyperglycemic drugs? |
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Definition
Sulfonylureas
Meglitidnides
Biguanides
Alpha Glucosidase Inhibitors
Thiazolidinediones |
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Term
Oral Antihyperglycemic:Sulfonylureas
Action:
Drugs:
When to be given:
Side Effects: |
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Definition
Oral Antihyperglycemic:Sulfonylureas
Action:Increase insulin production
Drugs:
First Generation: Diabinase, Orinase, and Tolazamide
Second Generation: Glyburide, Glipizide (Glucotrol), and Glucotrol XL
Third Generation: Amaryl
When to be given: 30 minutes before a meal at the same time each day
Side Effects: Weight gain, hypoglycemia, and sun sensitivity |
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Term
Oral Antihyperglycemic: Meglitinides
Action:
Drugs:
When to be given:
Side Effects: |
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Definition
Oral Antihyperglycemic:Meglitinides
Action: Increase insulin production
Drugs: Prandin (Repaglinide)
When to be given: 30 minutes before meals on an EMPTY stomach please
Side Effects: None |
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Term
Oral Antihyperglycemic: Biguanides
Action:
Drugs:
When to be given:
Side Effects: |
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Definition
Oral Antihyperglycemic: Biguanides
Action: Decrease hepatic glucose production, increase peripheral uptake of glucose, and insulin sensitizers
Drugs: Metformin (Glucophage)
When to be given: With the mel or towards the end at the same time of day
Side Effects: Check BUN/Creatinine levels, may cause renal failure with iodine contrast, may cause lactic acidosis, contraindicated in pts with CHF or ETOH use |
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Term
Oral Antihyperglycemic: Alpha Glucosidase Inhibitors
Action:
Drugs:
When to be given:
Side Effects: |
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Definition
Oral Antihyperglycemic: Alpha Glucosidase Inhibitors
Action: Block the absorption of carbohydrates in the small instestine
Drugs: Acarbose, Precose
When to be given: With first bite of meal; good to prevent postprandial glucose spike
Side Effects: Gas/bloating for 6 weeks, GI problems |
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Term
Oral Antihyperglycemic: Thiazolidinediones
Action:
Drugs:
When to be given:
Side Effects: |
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Definition
Oral Antihyperglycemic: Thiazolidinediones
Action: Insulin sensitizer
Drugs: Roziglitazone, Pioglitazone, and Troglitazone
When to be given: Same time of day
Side Effects: NO hypoglycemia, may cause ovulation in perimenopausal women, edema, weight gain, monitor liver |
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Term
| would sulfonylureas and meglitinides be appropriate treatments for a type 1 diabetic? |
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Definition
| no, because these both increase insulin production and the beta cells of a type 1 diabetic produce NO insulin at all. |
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Term
| what type of antihyperglycemics would be appropriate for type 1 diabetic use? |
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Definition
insulin senstizers: Biguanides and Thiazolidinediones
block carb absorption: Alpha Glucosidase Inhibitors
Decrease hepatic glucose production: Biguanides
Increase peripheral glucose uptake: Rosiglitazone and Pioglitazone and Biuguanides |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| normal values for: Protein |
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Definition
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Term
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Definition
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Term
| normal values for: Creatinine |
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Definition
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Term
| normal values for: Glucose |
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Definition
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Term
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Definition
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Term
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Definition
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Definition
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Term
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Definition
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Term
| normal values for: Specific Gravity of Urine |
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Definition
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Term
normal values for: PTT or APTT
for what drug therapy is this? |
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Definition
| 30-40 seconds; Heparin therapy |
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Term
normal values for: PT
what drug therapy is this for? |
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Definition
12-15 seconds
Coumadin (Warfarin) |
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Term
normal values for: INR (for normal people)
what is the therapeutic INR? |
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Definition
Normal: 0.8-1.2
Therapeutic: 2-3 |
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