1. Final Review PN 141 November/December 2014 Rebecca Maier, RN

2. Vision is achieved by?

3. Normal vision is determined by the Snellen test Normal vision is 20/20 Meaning you. Should be able to see. And read Line 8 at 20 feet Types of visual disorders include?

4. Vision Impairment What does blind mean? AHN -Pg 607 What are the nursing implications in writing the care plan? Is there more than 1 kind of blindness? Are there degrees of blindness? Are there ways of enhancing a blind person’s life? What community resources should the nurse make the blind person aware of?

5. For the newly blind patient What patient teaching needs to happen? What community resources should the patient and their family be aware of?

6. Cataracts AHN 617-618 causes, Signs and symptoms treatments teaching

7. Diabetic retinopathy Causes, treatments, – Cryotherapy – Photocoagulation nursing implications

8. Glaucoma Signs and symptoms Treatments – Rx – include rationale – surgery

9. Infectious diseases of the eye What do they look like What are the nursing implications What is the nurse’s number one goal

10. Noninfectious eye conditions Sjogren syndrome – S/S (signs and symptoms) – Causes – Dx – Tx Ectotropion

11. Loss of the eye Actual loss of the eye even if due to severely painful blindness is still a traumatic event for the patient. You must be cognizant of their need to grieve. Post operatively you need to apply pressure dressings to the socket to control bleeding.

12. The Ear Parts of the ear How does hearing work?

13. Hearing loss Causes – Structural Missing part Broken part – Environmental Noise Chemicals – Medical Medication – ototoxic

14. Common Issues Acute otitis media External otitis – Manifestations – what will the pat report? Otitis media – Occurs most frequently in children (why?) – Tx - Rx Labyrinthitis Obstruction

15. Meniere’s Disease Etiology/pathophysiology – Chronic disease of the inner ear – Recurrent episodes of vertigo  unilateral progressive nerve deafness, and tinnitus – Increase in endolymph fluid(  increased pressure in the inner ear) – The cause is unknown – Attack triggers: alcohol, nicotine, stress, and certain stimuli such as bright lights and sudden movements of the head

16. Meniere’s Disease Medical management No specific treatment Decrease fluid pressure – Fluid restriction; diuretics; low-salt diet Avoid caffeine and nicotine Dramamine, meclizine, and Benadryl – use between attacks Meds may be given IV during acute attacks

17. What is a Incusectomy?

18. What is a stapedectomy?

19. What are the nursing implications of a Stapedectomy? Pt positioning How is the pt going to feel when he first recovers post op? What post op teaching does the nurse need to give? What does the nurse need to be sure to tell the pt. about their hearing to relieve any anxiety?

20. What is a Tympanectomy?

21. Tympanoplasty is used to do what? perforated ear drums,. otosclerosis, or for dislocation necrosis of the small bones of the inner ear. These are all involved in conductive hearing loss – Why?

22. The Brain What are the parts and what do they do?

23. Cognitive Assessment Mental status assessment Orientation Mood and behavior General knowledge (AKA – Fund of knowledge) Short and long term memory

24. What is the Reticular Activating System? The reticular activating system (RAS) is a part of the brain located in the brain stem. In human biology, it is believed to play a role in many important functions, including sleep and waking, concentration, focus, behavioral motivation - introspection, breathing, and the beating of the heart. Trauma to this area can cause a coma, and it has been linked to several different medical conditions, including narcolepsy. The reticular activating system is located in the brain stem.

25. Head trauma Nursing interventions – what are they? Rhinorrhea – could be blood or serosanguineous Gently wipe do not clean orifice

26. Intracranial pressure What are the s/s of increased intracranial pressure? AHN 668 - 672

27. What is the appropriate nursing intervention to help reduce ICP? Elevate the head of the bed to 30 -45 degrees to promote venous return Place the neck in a neutral position (not flexed or extended to promote venous drainage Position the pt. to avoid flexion of the hips, the waist, and the neck and prevent any rotation of the head, especially to the right. Extreme flexion of the hip causes increased intra-abdominal and intra-thoracic pressure which can increase ICP.

28. What is the cardinal sign of increased intracranial pressure? Changes in LOC Pt will become increasingly lethargic and difficult to arouse.

29. Migraine headaches What causes them? How do they present – what will the nurse see or might the patient report? What does prodromal mean? How are they treated? What are the nursing implications?

30. Medications for migraine Eletriptan – All triptan Rx are serotonin receptor agonists Almotriptan Rizatriptan Ergotamine – Ergotamines may be used to stop or treat symptoms of an emerging migraine. – Ergotamines narrow (constrict) blood vessels in the brain. It is not clear how they work to stop a migraine. – may not be as effective as other migraine medicines, such as triptans.

31. Craniocerebral Injury Is Another name for? (Head trauma- concusion) Nursing implications?

32. What is a herniated disk?

33. What is a myelogram? Myelography (Myelogram) is a diagnostic examination of the spine. A special x-ray sensitive contrast dye is injected to illuminate the spine, allowing identification of problems within the spine, spinal cord and nerve roots. http://www.nebraskamed.com/health- library/3d-medical-atlas/174/myelography

34. What are the nursing implications of a myelogram? Pt teaching Pre procedure questions Post procedure teaching- reinforcement

35. Spinal cord injuries Signs and symptoms Nursing implications – Emergent situations Autonomic dysreflexia / hyperreflexia – Signs and symptoms Areflexia/spinal shock Diagnostics Management

36. Surgery practice question 10.What are surgical navigational systems? a.Computerized devices that guide the surgeon b.A set of detailed anatomic maps pinpointing specific areas of the brain c.A written set of progressive processes for the resection of small brain tumors d.The use of radioactive materials to pinpoint small tumors of the brain

37. What are surgical navigational systems? Brain Surgery Navigation Video URL: http://www.youtube.com/watch?v=jYCiKOERYD8http://www.youtube.com/watch?v=jYCiKOERYD8 Surgical navigational systems are computerized devices that guide the surgeon and make possible the resection of tumors that were once thought to be in operable.

38. Degenerative Disorders The most common are? – Alzheimer’s – Parkinson’s – Multiple Sclerosis – ALS – Organic brain pathology/syndrome (AKA – disturbed sensory and perceptual function) Their signs and symptoms are? Treatment is

39. Other neurological issues Seizures Causes: Unknown / idiopathic Causes Nursing considerations Family and patient teaching Epilepsy Causes Nursing considerations Family and patient teaching – what to expect

40. Other neurological issues Encephalitis – Dx – Tx Meningitis – Dx – Tx – Ns. Implications Guillain-Barre Syndrome – Dx and implications

41. Nursing implications When interviewing a patient about their neurological symptoms the nurse should use what kind of communication?