Eye/ Ear/ Skin
What is a normal IOP
IOP: 10-21
Calculate CPP. The MAP is 97 and the ICP is 9.
CPP: 88
Explain the difference in thyroid hormones for hyperthyroidism AND hypothyroidism
Hyperthyroidism: HIGH T 3/4 and LOW TSH
Hypothyroidism: LOW T 3/4 and HIGH TSH
You have a patient who has a 2nd-degree sprain to their ankle. What is the treatment?
RICE: rest, ice, compression, elevation
analgesics
48 hours after injury they can alternate heat/ice and limit use
What is the difference between fibrocystic breast conditions and benign tumors
· Fibrocystic Breast Conditions = enlarge and shrink with the menstrual cycle
· Benign Tumors… painful, hard/not squishy, fixed/doesn’t move = NOT good
What is the ABCDEs for melanoma?
A: asymmetry – is it symmetrical?
B: Border – does it have a regular border?
C: color – does it have more than one color?
D: diameter – is it larger than 6 mm
E: evolving appearance – has it changed over time?
Explain the difference between Broca's and Wernicke's aphasia
Broca's aphasia: inability to express written or spoken language --> frontal lobe
Wernike's aphasia: inability to understand written or spoken language --> temporal lobe
Explain the difference between the Somogyi effect and dawn phenomenon.
Symogyi effect: giving too much insulin and experiencing hypoglycemia overnight so the body over-compensates and has rebound hyperglycemia
Dawn-phenomenon: the release of growth hormone or cortisol which causes hyperglycemia and ketonuria when awakening
Explain the difference between Phalen's sign and Tinel's sign.
Phalen's sign: flexion of the wrist and hold for 1 min -- if paresthesia = positive
Tinel's sign: tapping on median nerve -- if paresthesia = positive
Explain the difference in the presentation of intraductal papilloma and ductal ectasia.
Intraductal papilloma: benign wart like growth on mammary duct -- bloody nipple discharge and palpable mass
ductal ectasia: swelling of several bilateral ducts -- multicolor, sticky nipple discharge that may progress to blood later.
What is nursing care for a patient with Meniere's Disease?
§ Antihistamines, anticholinergics, sedatives, benzos, antiemetics, antivertigo meds
§ Bed rest
§ Avoid nicotine, caffeine, alcohol, foods with MSG, low sodium diet
§ Avoid flickering lights and television during attacks
Explain the difference between multiple sclerosis and myasthenia gravis.
Multiple Sclerosis: autoimmune destruction/ demyelination of the myelin sheath and slow the conduction of nerve impulses
Myasthenia gravis: autoimmune diseases at the neuromuscular junction that lead to skeletal muscle weakness. Decreased number of ACH receptors.
You have a patient who just underwent a trans-sphenoidal removal of a pituitary adenoma. Name 4 post-op nursing responsibilities/ education points.
Increase HOB 30 degrees to decrease headache, oral care q 4 hr, education to not brush teeth for 10 days to protect suture line, monitor for drainage and test for CSF if needed, abx if signs of infection, spinal fluid leakage suspected if they have a persistent or severe generalized headache
Explain the difference between osteoarthritis and rheumatoid arthritis.
Osteoarthritis: slow, progressive non-inflammatory disease of the synovial joints -- see herberden nodules and should NOT work through the pain
rheumatoid arthritis: autoimmune disease see with pain, stiffness, limited of motion, swelling, and tenderness -- see Sjogren's syndrome, rheumatoid nodules, and felt syndrome.
Name 3 acute interventions for a patient post radical mastectomy.
§ Complete decongestive therapy (massage)
§ Elevation of the arm (level with the heart) … prevents compartment syndrome
§ Diuretics
§ Isometric exercises
§ Wearing a fitted compression sleeve during waking hours
§ Lifelong protection status-post mastectomy side: NO IV sticks, BP cuffs, injections
What is the difference between dry and wet macular degeneration.
o Dry MD: slow progression and painless vision loss
o Wet MD: more severe rapid vision loss with abnormal blood vessels forming around macula
Explain Brown Sequard Syndrome
Proprioception ipsilateral: loss of motor function, position, and vibratory on the side of the injury
pain/ temperature loss contralateral: loss of pain and temperature sensation on opposite side of injury
You have a patient who underwent a thyroidectomy. Name 4 nursing care/ education points.
Q2hr checks
· Semi-Fowler’s (HOB 30)
· VS
· Assess for signs of tetany (squeaking = stat Ca level check)
· Trousseau’s sign (carpal spasm with inflation of BP cuff)
· Chvostek’s sign (facial muscle spasm with tap or stroke of facial nerve in front of the ear)
· Control of post-op pain
Name 3 Do's and 3 Don'ts for hip fractures.
DO NOT for at least 6 weeks:
Force hip > 90 degrees flexion (need a lifted toilet seat)
Force hip into adduction/ cross legs
Force hip into internal rotation
Put on own shoes or stockings
Sit on chairs without arms or stand w/o assistance
Do's:
Use bedside toilet
Sit in shower chair when bathing
Keep him in a neutral position when walking, sitting, or lying
Use pillow between knees when lying on good side
Notify surgeon of severe pain or visible deformity
Prophylactic abx before dental surgery
Prevent internal and external rotation with pillows between legs and lateral to effected leg
Name four post-op TURP nursing care.
· Opiate suppositories for bladder spasms
· Push fluids to 2-3 L/day
· Assess for hyponatremia and fluid excess
· Maintain patency of the catheter… look for kinks!
· Pain management
· Mobilize patient by rolling side to side – worry about blocks in bladder (q2hr)
· May have order for continuous irrigation to prevent clot formation
Explain the difference between actinic keratosis, squamous cell carcinoma, and basal cell carcinoma.
actinic keratosis: a premalignant form of squamous cell carcinoma -- hyperkeratotic papules and plaques that can occur on sun-exposed skin
Squamous cell carcinoma: malignant neoplasm of keratinizing epidermal cells and occurs in sun-exposed areas.
basal cell carcinoma: locally invasive malignancy arising from epidermal basal cells with a low risk of metastasis. They are small slow growing papules with pearly boarders, erosion, ulceration, and depression at the center.
You have a patient who has a suspected basal skull fracture. What signs/ symptoms would you expect to see? The patient has clear fluid draining from their nose what would you do? What do you NEVER do with a patient who has a suspected basal skull fracture?
Battle sign: postauricular ecchymosis (bruising behind the ear)
Raccoon eyes: periorbital ecchymosis (bruising around the eye)
Clear fluid draining: possible CSF leak -- can do glucose test (40-70) and/or Halo test
NEVER EVER PLACE A BLIND NG TUBE
Explain the procedure and results of the water deprivation test for Diabetes Insipudus.
Procedure: hold all fluids at midnight and get baseline weight, urine specific gravity, and serum osmolality. get 3 postural BPs per hour and hourly urine samples. Weights at hours 4,6,7, and 8. Lastly give IV or SQ ADH
Results:
If normal/ psychological etiology: Urine specific gravity and serum osmolality = normal ---Patient needs to stop drinking so much water
If central DI: Serum osmolality > 300 ---Giving IV ADH helps increase or normalize = ADH deficiency
If nephrogenic DI: No response/ little response BECAUSE it is NOT an ADH issue sooooo giving ADH will not change the problem = it’s the kidneys
Name the 6 stages of fracture healing.
Fracture Hematoma: occurs within 72 hours of injury
Bleeding/ edema surrounding bone fragments-- turns to clot
Granulation of Tissue: occurs 3-14 days after injury
Local necrosis/ phagocytosis – clot turned into granulated tissue
Creates basis for new bone (osteoid)
Callus Formation: occurs usually 12-14 days after injury
Callus made up of cartilage, osteoblasts, calcium, phosphorus
Ossification: occurs 3-6 weeks after injury
Hardening of the callus
Consolidation:
Fragments move closer into proximity
Remodeling:
Excess tissue is absorbed, and bone is gradually strengthening and shaping
Name 6 nursing care points for a patient with pelvic inflammatory disease.
education regarding decreasing STD risk
allow expression of feelings (fear, regret, shame etc)
Monitor VS
document color, amt, odor of vaginal discharge
increase fluids
semi-fowlers – facilitates drainage (HOB 30 degrees)
assess abdomen to evaluate drug therapy
heat to abd and sitz bath if ordered ( if no abscess)
Analgesics
Abx therapy, corticosteroids, no intercourse 3wks
test partner for chlamydia/ gonorrhea.