Odor Of Orangutan Terrified Tarzan After Forty Voracious Gorillas Viciously Attacked Him
I Olfactory - smell
II Optic - vision
III Oculomotor - EOM
IV Trochlear - down and laterally
V Trigeminal - Sensation of cornea, skin of face and nasal mucosa
VI Abducens - laterally
VII Facial - facial expression, taste, anterior two-thirds of tongue
VIII Vestibulocochlear - hearing & balance
IX Glossopharyngeal - swallowing ability, tongue movement, taste
X Vagus - sensation of pharynx and larynx, swallowing, vocal cord movement
XI Accessory - head & shrugging shoulders
XII Hypoglossal - protrusion of tongue, moves tongue up and down and side to side
Olfactory
I
Smell
I
Olfactory
Smell
Optic
II
Vision and visual field
II
Optic
Vision and visual field
Oculomotor
III
Extraocular eye movement (EOM)
III
Oculomotor
Extraocular eye movement (EOM)
Trochlear
IV
EOM, movement of the eyeball downward and laterally
IV
Trochlear
EOM, movement of the eyeball downward and laterally
Trigeminal
V
Sensation of cornea, skin of face and nasal mucosa
V
Trigeminal
Sensation of cornea, skin of face and nasal mucosa
Abducens
VI
EOM, moves eyeball laterally
VI
Abducens
EOM, moves eyeball laterally
Facial
VII
Facial expression, taste, anterior two-thirds of tongue
VII
Facial
Facial expression, taste, anterior two-thirds of tongue
Vestibulocochlear
VIII
Equilibrium, Hearing
VIII
Vestibulocochlear
Equilibrium, Hearing
Glossopharyngeal
IX
Swallowing ability, tongue movement, taste
IX
Glossopharyngeal
Swallowing ability, tongue movement, taste
Vagus
X
Sensation of pharynx and larynx, swallowing, vocal cord movement
X
Vagus
Sensation of pharynx and larynx, swallowing, vocal cord movement
Accessory
XI
Head movement, shrugging of shoulders
XI
Accessory
Head movement, shrugging of shoulders
Hypoglossal
XII
Protrusion of tongue, moves tongue up and down and side to side
XII
Hypoglossal
Protrusion of tongue, moves tongue up and down and side to side
Mnemonic for remembering which cranial nerves are S=sensory, M=motor, or B=both.
Some
Say
Marry
Money
But
My
Brother
Says
Bad
Business
Marry
Money
The client has returned to the unit after a thymectomy and is extubated. The client begins to report chest pain. What will the nurse do next?
D. Informs the surgeon immediately
The cause of chest pain is noncardiac in nature and is possibly related to a hemothorax or a pneumothorax because of the sternal split surgical approach.
AAA has parasympatholytic effects and is the antidote for edrophonium chloride (Tensilon), the pharmacological drug for DX of BBB.
A) Atropine
B) MG
The nurse is assessing a client admitted with myasthenia gravis. Which of these focused assessment findings are likely to be present in clients with this disease? (Select all that apply.)
A. Ascending paralysis
B. Ptosis
C. Dysphagia
D. Distal muscle weakness
E. Hypertension
F. Dysarthria
ANS: B, C, E, F
Rationale: The client with myasthenia gravis will probably present with these symptoms:
B. Ptosis - droopy eye lids
C. Dysphagia - difficulty in chewing and swallowing
E. Hypertension - possible if patient is in myasthenic crisis
F. Dysarthria - difficult or defective speech due to impairment of the tongue
A 50-year-old man is admitted to your unit from a physician's office. He reports increasing muscle weakness and pain. He now has paresthesia that has progressed to his trunk. A diagnosis of Guillain-Barré is made. The physician has prescribed immunoglobulin therapy. What is the most effective way to manage the pain related to paresthesia?
C) Opiates
The typical pain experienced is often not relieved by medication other than opiates.
A 50-year-old man is admitted to your unit from a physician's office. He reports increasing muscle weakness and pain. He now has paresthesia that has progressed to his trunk. A diagnosis of Guillain-Barré is made. The physician has prescribed immunoglobulin therapy. Which medication may be prescribed to prevent a common complication of immobility?
B) Enoxaparin (Lovenox)
Because pulmonary emboli and deep vein thrombosis are common complications of immobility, the health care provider may prescribe prophylactic anticoagulant therapy such as Lovenox.
A 45-year-old female is admitted to your unit for diagnostic testing to rule out myasthenia gravis. She tolerated the testing procedure well and has started taking a cholinesterase inhibitor pyridostigmine (Mestinon). She wants to know how this medication works. What is your best response?
A) "It increases the response of the muscles to nerve impulses and improves muscle strength."
Cholinesterase inhibitor drugs are the first-line management of MG. These drugs are also referred to as anticholinesterase drugs or antimyasthenics. They enhance neuromuscular impulse transmission by preventing the decrease of ACh by the enzyme ChE, thus increasing the response of the muscles to nerve impulses and improving muscle strength. The ChE drug of choice is pyridostigmine (Mestinon, Regonol). Expect day-to-day variations in dosage depending on the patient's fluctuating symptoms.
A 50-year-old man is admitted to your unit from a physician's office. He reports increasing muscle weakness and pain. He now has paresthesia that has progressed to his trunk. A diagnosis of Guillain-Barré is made. The physician has prescribed immunoglobulin therapy. What are the possible side effects from immunoglobulin g (IVIg) therapy? Select all that apply.
A) Fever
B) Headache
C) Anaphylaxis
D) Acute renal failure
All
Side effects can range from minor annoyances to major complications.
A 45-year-old female is admitted to your unit for diagnostic testing to rule out myasthenia gravis. She has been experiencing all the typical symptoms but has not had a definitive diagnosis. What adverse effect(s) should you monitor for in this patient? Select all that apply.
A) Ventricular fibrillation
B) Cardiac arrest
C) Migraine headache
D) Seizures
A & B
The Tensilon test poses a danger of ventricular fibrillation and cardiac arrest, but these reactions rarely occur.
The antidote is atropine sulfate
You are caring for a patient with Guillain-Barré syndrome who is receiving immunoglobulin (IVIg). Which patient finding warrants immediate evaluation?
C) Headache with stiff neck
This may be a sign of aseptic meningitis, a possible serious complication of IVIg therapy. Low-grade fever, chills, and myalgia are minor side effects of IVIg therapy and do not indicate that the therapy should be stopped.
The client has Guillain-Barré syndrome. Which interdisciplinary health care team members should collaborate to help prevent pressure ulcers related to immobility in this client? (Select all that apply.)
A. Family
B. Nurse
C. Nutritionist
D. Occupational therapist (OT)
E. Patient
All
Malnutrition places clients at risk for pressure ulcers, especially when the client is immobile.
The client's spouse expresses concern that the client, who has Guillain-Barré syndrome, is becoming very depressed and will not leave the house. What is the nurse's best response?
A) ''You can contact the Guillain-Barré Foundation International for resources.''
The Guillain-Barré Foundation International (www.gbsi.com) provides resources and information for clients and their families. The client and family should be referred to self-help and support groups for clients with chronic illness, if indicated.
Invite one close friend over is appropriate, but more than that might overwhelm the client.
The client with myasthenia gravis is receiving cholinesterase inhibitor drugs to improve muscle strength. The nurse is educating the family about this therapy. Which statement by a family member indicates a correct understanding of the nurse's instruction?
C) ''I should call 911 if there is a sudden increase in weakness.''
A potential adverse effect of cholinesterase inhibitors is cholinergic crisis. Sudden increases in weakness and the inability to clear secretions, swallow, or breathe adequately indicate that the client is experiencing crisis. The family member should call 911 for emergency assistance.
The dose of cholinesterase inhibitors should never be increased without provider supervision
Cholinesterase inhibitors should be taken with a small amount of food to help alleviate GI side effects, and the client should eat their mainmeal 45 to 60 minutes after taking cholinesterase inhibitors to avoid aspiration.
The client arrives to the emergency department with new onset ptosis, diplopia, and dysphagia. The nurse anticipates the client will be tested for which neurologic disease?
A) Myasthenia gravis
The symptoms of Bell's palsy include facial paralysis. The face appears masklike and sags.
Symptoms for GBS typically begin ...
in the legs and spread to the arms and upper body
The symptoms of Bell's palsy include ...
facial paralysis. The face appears masklike and sags.
Sudden onset of ptosis, diplopia, and dysphagia are classic symptoms of AAA. Laboratory studies and BBB will most likely be done to confirm diagnosis.
A) MG
B) a Tensilon test
Which statement illustrates the commonality between Guillain-Barré syndrome and myasthenia gravis?
A) Both diseases affect respiratory status and muscle function of the client.
Of GBS and MG, XXX is an autoimmune disease with ocular symptoms.
MG
Of GBS and MG, XXX is characterized by exacerbations and remissions whereas GBS has three acute stages.
MG
Of GBS and MG, XXX causes demyelination of the peripheral neurons.
GBS
The client is admitted with an exacerbation of Guillain-Barré syndrome, presenting with facial weakness, dysphagia, and difficulty speaking. On admission, the client is having mild dyspnea. Which intervention does the nurse perform first?
B) Raises the head of the bed to 45 degrees
The head of the client's bed should be raised to 45 degrees because it allows increased lung expansion, which improves the client's ability to breathe.
The client is being evaluated for signs associated with myasthenia crisis or cholinergic crisis. Which symptoms lead the nurse to suspect that the client is experiencing a cholinergic crisis?
B) Abdominal cramps, blurred vision, facial muscle twitching
Bowel and bladder incontinence, pallor, and cyanosis are all symptoms indicating a ...
myasthenic crisis
Increased pulse, anoxia, and decreased urine output are all symptoms indicating a ...
myasthenic crisis
Restlessness, increased salivation and tearing, and dyspnea are symptoms indicating ...
a mixed myasthenic-cholinergic crisis
Use of over-the-counter drugs [is - is not] contraindicated for clients with restless legs syndrome.
is not
Bell's palsy is caused by ...
the herpes simplex virus
T/F: Bell's palsy and trigeminal neuralgia both can cause choking, coughing, or eructation
True
Bell's palsy and trigeminal neuralgia both are disorders of:
A) the autonomic nervous system.
B) the cranial nerves.
B) the cranial nerves.
T/F: Bell's palsy and trigeminal neuralgia both disorders display facial twitching.
False
Facial twitching can be a sign of trigeminal neuralgia, whereas Bell's palsy causes a unilateral facial paralysis.
Trigeminal neuralgia is ...
thought to be caused by excessive firing of irritated nerve fibers in the trigeminal nerve.
A client with myasthenia gravis has been prescribed to take pyridostigmine (Mestinon). What health teaching will the nurse include related to this drug? Select all that apply.
A. “Watch for signs and symptoms of myasthenic crisis.”
B. “Take the drug about an hour before eating a meal.”
C. “Take the same dose of medication every day.”
D. “Take the drug with food to prevent nausea.”
E. “Do not take sedatives or sleeping pills while on this drug.”
A, B, C, E
Rationale: The client and family should watch for an exacerbation of myasthenic symptoms caused by underdosing of anticholinesterase drugs. The client should eat meals 45 minutes to 1 hour after taking pyridostigmine to avoid aspiration; this is especially important if the client has bulbar involvement. The client should be told that he or she should take the same dose of medication daily and on time to maintain blood levels and improve muscle strength; changing doses daily will interfere with interpretation of blood levels and adjustment of the doses. The client should not take drugs containing magnesium, morphine (or its derivatives curare, quinine, quinidine, procainamide), or hypnotics or sedatives because they may increase weakness. The client should not take pyridostigmine with food.
The client arrives to the emergency department with new-onset ptosis, diplopia, and dysphagia. The nurse anticipates that the client will be tested for which neurologic disease?
D. Myasthenia gravis (MG)
T/F: Symptoms of MG include facial paralysis. The face appears masklike and sags.
False
Symptoms of Bell's palsy include facial paralysis. The face appears masklike and sags.
T/F: Sudden-onset ptosis, diplopia, and dysphagia are classic symptoms of MG
True
T/F: Of GBS and MG, only GBS is an autoimmune disease with ocular symptoms.
False
Only MG is an autoimmune disease with ocular symptoms.
T/F - myasthenic crisis: Abdominal cramps, blurred vision, and facial muscle twitching are signs of an acute exacerbation of muscle weakness caused by overmedication with cholinergic (anticholinesterase) drugs.
False
cholinergic crisis
T/F: Bowel and bladder incontinence, pallor, and cyanosis are symptoms indicating a myasthenic crisis.
True
myasthenic crisis symptoms:
bowel and bladder incontinence
pallor
cyanosis
increased pulse
anoxia
decreased urine output
mixed myasthenic-cholinergic crisis symptoms
restlessness
increased salivation and tearing
dyspnea
Presbyopia is a condition where, with age (around AAA), the eye exhibits a BBB.
A) 40
B) progressively diminished ability to focus on near objects
Decongestants and antihistamines may tend to AAA and may cause BBB.
A) dry the eye
B) increased IOP
About AAA% of people have a noticeable difference between the size of their pupils. This is called BBB.
A) 5
B) anisocoria
Pupil reaction to light of 1 second or less is termed AAA, while longer than 1 second is termed BBB. No reaction is termed CCC or DDD.
A) brisk
B) sluggish
C) fixed
D) nonreactive
AAA is an involuntary rapid twitching of the eye and is a BBB finding for the CCC gaze. It may also be caused by DDD or EEE.
A) Nystagmus
B) normal
C) far lateral
D) abnormal nerve function
E) prolonged reduced vision
Color vision is most often tested with a AAA chart
Ishihara
AAA is used to measure IOP and a normal reading would be BBB, although CCC% of patients with healthy eyes have slightly higher pressure.
A) Tonometry
B) 10-21 mm Hg
C) 5
AAA eye drops cause pupil dilation and should be instilled BBB before tests such as fluorescein angiography.
A) Mydriatic
B) 1 hour
AAA is an inflammation of the eyelid edges, occurs most often in the older adult and those with dry-eye syndrome. BBB (greasy, itchy scaling) of the eyebrows and eyelids is often present.
A) Blepharitis
B) Seborrhea
An AAA is the turning inward of the eyelid causing the lashes to rub against the eye. AAA can be caused by BBB or by scarring and deformity of the eyelid as a result of trauma. AAA occurs often among older adults because of age-related loss of tissue support.
A) entropion
B) eyelid muscle spasms
The patient is an 86-year-old man who lives alone at home and is scheduled to have fluorescein angiography tomorrow. He still drives and performs all of his own housekeeping responsibilities. In addition, he drives his neighbor, who is blind, to a sheltered workshop every day. The patient calls today with some concerns about whether he will be able to drive himself to and from the procedure, pain during the procedure, and whether he will be able to play poker with his friends later tomorrow night after the test.
1. Should he drive himself to and from the procedure? Why or why not?
He should not drive himself to and from the procedure. He will be given drugs that widely dilate his pupils, making him extremely sensitive to light.
The patient is an 86-year-old man who lives alone at home and is scheduled to have fluorescein angiography tomorrow. He still drives and performs all of his own housekeeping responsibilities. In addition, he drives his neighbor, who is blind, to a sheltered workshop every day. The patient calls today with some concerns about whether he will be able to drive himself to and from the procedure, pain during the procedure, and whether he will be able to play poker with his friends later tomorrow night after the test.
2. What should you tell him regarding the preparation and actual fluorescein angiography procedures?
Explain that his pupils will be dilated and that a dye will be injected IV. After a few minutes, a camera will record the blood flow through his eye. Except for the IV access, the procedure is painless. Warn that the dye may cause the skin to appear yellow for several hours after the test. The stain is eliminated through the urine, which also changes color.
The patient is an 86-year-old man who lives alone at home and is scheduled to have fluorescein angiography tomorrow. He still drives and performs all of his own housekeeping responsibilities. In addition, he drives his neighbor, who is blind, to a sheltered workshop every day. The patient calls today with some concerns about whether he will be able to drive himself to and from the procedure, pain during the procedure, and whether he will be able to play poker with his friends later tomorrow night after the test.
3. What should you teach him about altering his usual activities during the first 24 hours after the procedure?
He can engage in most of his usual activities after the procedure; however, until pupil dilation returns to normal, exposure of the eyes to sunlight and other bright lights will cause eye pain. Therefore tell him to wear dark glasses and avoid direct sunlight. He should not golf today but can play cards. Also, encourage him to drink fluids to help eliminate the dye. Remind him that any yellow or green staining of the skin will disappear in a few hours.
Gradual vision loss could be caused by AAA or BBB and CCC[does/does not] require immediate care by an ophthalmologist.
A) uncontrolled hypertension
B) diabetes
C) does not
Which systemic disorders may affect the eye and vision and require yearly eye examinations by an ophthalmologist? (Select all that apply.)
A. Anemia
B. Diabetes mellitus
C. Hepatitis
D. Hypertension
E. Multiple sclerosis
B, D, E
The nurse is teaching the client who is scheduled for an ultrasonography of the eye. Which statement by the client indicates a need for further instruction?
D. ''I'll have to wear a bandage over my eye after the test.''
No special follow-up care is needed. However, remind the client not to rub or touch the eye until the effects of the anesthetic drops have worn off.
Ultrasonography aids in the diagnosis of
trauma,
intraorbital tumors,
proptosis,
choroidal or retinal detachments.
Exophthalmos, also called proptosis, is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in an orbital tumor).
Clients with a family history of which eye disorder may have problems with increased intraocular pressure (IOP), requiring additional assessment?
B. Glaucoma
Diabetic retinopathy is microvascular damage caused by uncontrolled diabetes, not increased IOP.
Cataracts are a result of increased IOP, not a cause. Increased IOP clouds the lens of the eye, potentially causing cataracts to develop.
The six cardinal positions of gaze assess cranial nerve(s) ...
III Oculomotor - extraocular eye movement
IV Trochlear - movement of the eyeball downward and laterally
VI Abducens - moves eyeball laterally
The confrontation test assesses the client's ...
visual field. It is a crude test that takes the place of a machine test, but you cover right to their left (same field) and both notice object entering that field at same time.
Keratoconjunctivitis Sicca is AAA and can be caused by BBB, CCC, and DDD.
A) dry-eye syndrome
B) change in tear composition
C) lacrimal gland malfunction
D) changes in tear distribution
Reduced tear production often leads to AAA of the eye structures, because tears BBB.
A) bacterial infection
B) inhibit bacterial growth
Patients with extropian often have ...
constant tears and a sagging lower eyelid.
An internal hordeolum is caused by an AAA of the eyelid sebaceous glands and occurs with pain, whereas an inflammation of these glands results in BBB which is CCC.
A) infection
B) chalazion
C) painless
Decreased tear production can also occur with the use of some drugs, such as AAA, BBB and CCC.
A) antihistamines
B0 beta-adrenergic blocking agents
C) anticholinergic drugs.
Diseases associated with decreased tear production include ...
rheumatoid arthritis
leukemia
sarcoidosis
multiple sclerosis
Injury to the AAA nerve inhibits tears.
A) facial (cranial nerve VII)
A hordeolum is caused by an infection of the eyelid sebaceous glands(AAA) or (BBB) where the lashes meet the eyelid. The most common causative organisms are CCC, DDD and EEE,
A) internal
B) external
C) Staphylococcus aureus
D) Staphylococcus epidermidis
E) Streptococcus
Conjunctivitis is an inflammation or infection of the conjunctiva. Inflammation occurs from exposure to AAA or BBB and is not contagious.
A) allergens
B) irritants
Trachoma is a chronic, bilateral scarring form of conjunctivitis caused by ...
Chlamydia trachomatis.
Trachoma is treated with ...
a 4-week course of oral or topical tetracycline (Achromycin, Apo-Tetra) or erythromycin (Apo-Erythro-EC, E-Mycin, E.E.S.) is given. Azithromycin(Zithromax) can be used once per week for 1 to 3 weeks.
T/F: The cornea can defend itself from infections that have the potential to permanently impair vision.
False: The cornea does not have a separate blood supply (antibodies).
corneal transplant is called a
keratoplasty
Corneal donors must be free of infectious disease or cancer at the time of death. If a deceased patient is a potential eye donor, follow these steps:
Raise the head of the bed 30 degrees.
Instill antibiotic eyedrops, such as Neosporin or tobramycin.
Close the eyes, and apply a small ice pack to the closed eyes.
Contact the family and physician to discuss eye donation.
In open-angle (primary) glaucoma, the tonometry reading is between
22 and 32 mm Hg
In angle-closure glaucoma, the tonometry reading may be ...
30 mm Hg or higher.
When a high IOP is found this test AAA, determines whether open-angle or closed-angle glaucoma is present. It uses a special lens that eliminates the corneal curve, is painless, and allows visualization of the angle where the iris meets the cornea.
Gonioscopy
AAA is commonly used for those people with ocular hypertension or who are at risk for glaucoma from other problems. T
Optic nerve imaging
The AAA muscle is a ring of striated smooth muscle in the eye's middle layer (vascular layer) that controls accommodation for viewing objects at varying distances and regulates the flow of aqueous humour into Schlemm's canal. It changes the shape of the lens within the eye, not the size of the pupil which is carried out by the BBB muscle.
A) ciliary
B) sphincter pupillae
The five most common classes of drugs to manage glaucoma are the ...
prostaglandinsagonists
adrenergic agonists
beta-adrenergic blockers
cholinergic agonists
carbonic anhydrase inhibitors
The patient is an 82-year-old widower who lives in a retirement village. He has had cataracts for about 10 years, with the right one advancing faster than the left, and wants the surgery because his vision is too poor to pass the driving test. (The retirement community’s minibus brought him to the clinic.) He takes his meals in the dining facility and has weekly housekeeping/laundry service. He plays golf daily, using a golf cart, and plays cards every evening. He is scheduled for surgery next week and is in the clinic today for preoperative teaching. In addition to cataracts, he has osteoarthritis of both knees and is on hormonal therapy for prostate cancer. His drugs include aspirin 650 mg twice daily, losartan (Cozaar) 50 mg daily for moderate hypertension, and a multiple vitamin.
Should any of his drugs be changed before surgery? Which one(s) and why?
The aspirin should be stopped at least 10 days before the surgery because it disrupts platelet aggregation and can lead to excessive bleeding at any surgical site.
The patient is an 82-year-old widower who lives in a retirement village. He has had cataracts for about 10 years, with the right one advancing faster than the left, and wants the surgery because his vision is too poor to pass the driving test. (The retirement community’s minibus brought him to the clinic.) He takes his meals in the dining facility and has weekly housekeeping/laundry service. He plays golf daily, using a golf cart, and plays cards every evening. He is scheduled for surgery next week and is in the clinic today for preoperative teaching. In addition to cataracts, he has osteoarthritis of both knees and is on hormonal therapy for prostate cancer. His drugs include aspirin 650 mg twice daily, losartan (Cozaar) 50 mg daily for moderate hypertension, and a multiple vitamin.
What are the priority areas of assessment for this patient? Provide a rationale for your choices.
Assess his understanding and likelihood of adhering to the postoperative eyedrop drug therapy. This drug therapy is critical for preventing complications after cataract surgery, and a series of eyedrops may be needed as often as 4 times a day for 2 to 4 weeks. Assess his ability to correctly instill eyedrops and to be able to distinguish one type of drug from another.
The patient is an 82-year-old widower who lives in a retirement village. He has had cataracts for about 10 years, with the right one advancing faster than the left, and wants the surgery because his vision is too poor to pass the driving test. (The retirement community’s minibus brought him to the clinic.) He takes his meals in the dining facility and has weekly housekeeping/laundry service. He plays golf daily, using a golf cart, and plays cards every evening. He is scheduled for surgery next week and is in the clinic today for preoperative teaching. In addition to cataracts, he has osteoarthritis of both knees and is on hormonal therapy for prostate cancer. His drugs include aspirin 650 mg twice daily, losartan (Cozaar) 50 mg daily for moderate hypertension, and a multiple vitamin.
What community resources should you check for this patient?
Determine whether the retirement village has nursing services that can oversee his eyedrop therapy and can assess the appearance of the eye. If the village does not have these services, work with the patient to determine whether a friend can perform these activities or whether a home care nurse will be needed on a short-term basis.
The patient is a 72-year-old man with colorectal cancer having surgery today for placement of an implanted venous access device for chemotherapy. You remember him from his last ambulatory surgery. He lists all the prescribed drugs he is currently taking but does not mention the eyedrops he was using 6 months ago for his glaucoma. When you ask him about this omission he tells you that he stopped taking the eyedrops a few months ago and is now “curing his glaucoma” by drinking 6 cups of green tea and taking 5000 mg of vitamin C each day. He asks you not to tell his oncologist because “he isn’t into alternative medicine.”
What assessment should you perform or ask related to the glaucoma?
Ask him when the last time his intraocular pressure was measured. Check his visual acuity and visual fields. Document these findings, and compare them with previous assessments (if those are available in his medical record). If you are skilled at IOP measurement, check his IOP. If you are not, have an advanced practice nurse or another health care provider measure it.
The patient is a 72-year-old man with colorectal cancer having surgery today for placement of an implanted venous access device for chemotherapy. You remember him from his last ambulatory surgery. He lists all the prescribed drugs he is currently taking but does not mention the eyedrops he was using 6 months ago for his glaucoma. When you ask him about this omission he tells you that he stopped taking the eyedrops a few months ago and is now “curing his glaucoma” by drinking 6 cups of green tea and taking 5000 mg of vitamin C each day. He asks you not to tell his oncologist because “he isn’t into alternative medicine.”
What should you tell him about his choice of glaucoma therapy?
Tell him that most substances taken orally, including vitamins and other health food products, have only minor effects on intraocular pressure. These may work with the prescribed eyedrops to prevent further loss of vision. Remind him that vision loss from glaucoma is permanent and that the only prevention is keeping IOP within the normal range.
The patient is a 72-year-old man with colorectal cancer having surgery today for placement of an implanted venous access device for chemotherapy. You remember him from his last ambulatory surgery. He lists all the prescribed drugs he is currently taking but does not mention the eyedrops he was using 6 months ago for his glaucoma. When you ask him about this omission he tells you that he stopped taking the eyedrops a few months ago and is now “curing his glaucoma” by drinking 6 cups of green tea and taking 5000 mg of vitamin C each day. He asks you not to tell his oncologist because “he isn’t into alternative medicine.”
How should you respond to the patient’s request to not tell his oncologist about the change in glaucoma treatment? Provide a rationale for your response.
Tell him that his oncologist needs to know about any vitamin supplements or other drugs to determine whether there could be a possible interaction with his chemotherapy. Remind him that his ophthalmologist should continue to be involved in his eye care, even during his cancer treatment.
The client who has just had cataract removal and lens replacement in his right eye asks whether he can play cards this evening and go golfing tomorrow. What is the nurse’s best response?
B. “Playing cards is fine, but you need to refrain from golfing for about 2 weeks.”
The client needs to avoid activities that increase intraocular pressure (IOP) for the first 2 weeks after cataract removal. Playing golf involves bending over to work with the ball and lifting the bag of golf clubs, both of which would increase IOP. In addition, swinging the golf club promotes eye motion and could dislodge the lens.
Situation: Your patient is a 68-year-old woman who has just undergone cataract surgery. She has never been hospitalized and expresses concern about how to use her medication and what she should expect from her medication. She is prescribed tobramycin with dexamethasone (TobraDex). Which of these indicate the appropriate way to instill ophthalmic ointment? Select all that apply.
A. Wash your hands.
B. Wear gloves.
C. Pull the patient’s lower lid downward to create a pocket.
D. Gently touch the tip of the tube to the conjunctiva and squeeze a small amount of ointment.
A, B and C
Situation: Your patient is a 68-year-old woman who has just undergone cataract surgery. She has never been hospitalized and expresses concern about how to use her medication and what she should expect from her medication. She is to be discharged with TobraDex eyedrops. What should you include in your instructions? Select all that apply.
A. Rub the eye gently after instillation of medication.
B. Use nasal punctual occlusion.
C. Separate the instillation of each drug by at least 5 minutes.
D. Administer medications by eye instillation route, not the oral route.
B, C and D
Situation: Your patient is a 68-year-old woman who has just undergone cataract surgery. She has never been hospitalized and expresses concern about how to use her medication and what she should expect from her medication. She tells you she thinks she will have difficulty instilling eyedrops. Which of these should you include with your discharge instructions? Select all that apply.
A. She will be able to learn with practice.
B. Adaptive equipment can be purchased to help position the bottle of eyedrops.
C. Refrigerate the eyedrops.
D. There are no activity restrictions.
A, B and C
Situation: Your patient is a 45-year-old with glaucoma. She has been started on bimatoprost (Lumigan) to decrease the intraocular eye pressure. What patient teaching should you give this patient concerning this medication and glaucoma treatment? Select all that apply.
A. Check the cornea for abrasions or other signs of trauma.
B. Over time, the eye color will darken and eyelashes will elongate.
C. Adherence to the prescribed dose is critical to maintain the drug’s effectiveness.
D. Use the drops in the nonaffected eye to ensure that eye colors remain the same.
A, B and C
Situation: Your patient is a 45-year-old with glaucoma. She has been started on bimatoprost (Lumigan) to decrease the intraocular eye pressure. She has taken the drug for several days, but the intraocular pressure has increased. What oral or IV medication(s) may be given to decrease the pressure to an acceptable level? Select all that apply.
A. Oral Osmoglyn
B. IV mannitol
C. Oral furosemide
D. IV thiazide diuretics
A and B
Systemic osmotic drugs may be given for angle-closure glaucoma as part of emergency treatment to rapidly reduce IOP. These agents include oral glycerin (Osmoglyn) and IV mannitol (Osmitrol).
Situation: Your patient is a 45-year-old with glaucoma. She has been started on bimatoprost (Lumigan) to decrease the intraocular eye pressure. She has presented to the ED after a camping trip with a corneal abrasion and was started on an ophthalmic ointment. What instructions does this patient need to know to instill the ointment properly? Select all that apply.
A. Wash your hands.
B. Do not touch the eye or lid with the tip of the tube.
C. Start at the nose side of the eye and move toward the outer edge.
D. If both eyes needing treatment and only one is infected, it is okay to use the same tube for both eyes.
A, B and C
A hospitalized patient who is a potential corneal donor has just expired. Which nursing action can you delegate to the nursing assistant?
C. Elevate the head 30 degrees, and apply ice packs.
The nurse has interviewed these patients in the emergency department triage area. Which one warrants immediate medical evaluation?
A. The 18-year-old with periorbital ecchymosis acquired during an altercation
B. The 24-year-old who has a foreign body sensation in the right eye after gardening
C. The 30-year-old with nausea after a scleral buckling procedure yesterday
D. The 35-year-old who has sudden-onset eye pain and decreased vision
D. The 35-year-old who has sudden-onset eye pain and decreased vision
The patient's clinical manifestations are consistent with a corneal laceration - a medical emergency because the eye contents may prolapse through the laceration. The other patients also need assessment but are not as high a priority as the patient with possible corneal laceration.
You are caring for a patient with bacterial conjunctivitis. Which of these actions should you take first?
C. Collect the requested culture of the drainage.
After having a lens implant, a patient calls the ophthalmology clinic the next day and tells the nurse about all of these symptoms. Which one requires the most immediate action by the nurse?
D. The eye feels painful.
Pain soon after lens implant surgery may indicate an increase in intraocular pressure and needs to be assessed immediately. The other patient symptoms are common after this surgery.
Which client is most in need of immediate examination by an ophthalmologist?
A. 40-year-old with glasses and a reddened sclera who reports brow pain, headache, and seeing colored halos around lights
This client is exhibiting signs and symptoms of increased intraocular pressure. This is a priority because the optic nerve can be damaged, which can cause possible blindness. Acute angle closure glaucoma can occur in those 40 years old and older.
The nurse is teaching the mother of a teenage client with conjunctivitis how to administer eye ointment. Which statement by the mother indicates a correct understanding of the nurse's instruction?
D. ''I will place the ointment in the lower lid.''
Pressing on the inner canthus is a technique reserved for the instillation of glaucoma drops.
The nurse is performing preoperative teaching for the older adult client who will be having a cataract removed.
T/F: You will need to wear a patch on your eye for several weeks after the surgery.
False
The eye is left unpatched and the client is sent home 1 hour after surgery.
The client who recently lost vision in one eye says, ''I feel as if I am mourning the 'death' of my eye.'' What is the nurse's best response?
A. ''That is a very normal response.''
Clients benefit from the honest support that the nurse can provide. They need to hear that it is normal to mourn, cry, and feel the loss of the eye. The client may feel hopeless and angry but, with time, anger usually gives way to acceptance.
''Do you think you are depressed?' - 'Incorrect: This is an example of a nontherapeutic communication technique called interpreting.
The client with new-onset diminished vision is being discharged and is concerned about living independently. Which technique best facilitates independent self-care for the client?
C. Building on the remaining vision
Using large print books, talking clocks, and telephones with large, raised block numbers are examples of building on the client's remaining vision.
Keeping the floor free of clutter - Incorrect: Keeping the floor free of clutter is important, but is too specific. There is a better answer.
Which symptom indicates the need for reassessment in the client with glaucoma?
D. Gradual vision changes
Gradual vision changes are an indication of IOP.
Burning in the eye Incorrect: A burning sensation in the eye usually indicates inflammation and/or infection.
Inability to differentiate colors - Incorrect: An inability to differentiate colors is an early sign of cataracts.
Increased sensitivity to light - Incorrect: An increased sensitivity to light might be a sign of a corneal abrasion.
The symptoms of AAA include facial paralysis. The face appears masklike and sags. It is caused by BBB.
A) Bell's palsy
B) herpes simplex virus
An inability to differentiate colors is an early sign of ...
cataracts
An increased sensitivity to light might be a sign of ...
a corneal abrasion
Gradual vision changes are an indication of ...
IOP
What is the action of miotics in the client with glaucoma?
B. Enhances aqueous outflow
Steroid eyedrops, not miotics, decrease the inflammatory process.
AAA fills the space between the lens and the retina, is stagnant, and is not replenished like the BBB.
A) Vitreous humor
B) aqueous humor
After the nurse has examined a patient's ear using an otoscope, which finding is most important to report to the physician?
C. Pain occurs when pulling the pinna up and back.
Pain when manipulating the pinna is an unexpected finding that should be investigated further, since it may indicate acute problems such as otitis media. A and C are normal findings, and B may be the result of an old middle ear infection or trauma.
A patient who was referred to the hearing clinic tells the nurse, "I am here because I have dizziness." Which test will the nurse anticipate will be done first?
D. Dix-Hallpike test
The Dix-Hallpike test assesses vertigo and does not require any special patient preparation. The other tests may also help in diagnosing causes of vertigo but require more patient preparation such as fasting before the exam.
The patient should AAA before BBB to avoid nausea.
A) fast for several hours
B) caloric testing
The client must AAA before electronystagmography and avoid caffeine-containing beverages for BBB before the test.
A) fast for several hours
B) 24 to 48 hours
The older adult client comes in for a routine visit. During the assessment, he irritably exclaims, ''Speak up and quit mumbling!'' How does the nurse respond?
B. Apologizes and speak louder and clearer
Speak more clearly first and then determine if further assessment is needed.
Do not assume that the client has hearing loss. This suggestion may make the client more irritable, especially if the client is in denial.
Which clients have a high risk of developing hearing problems? (Select all that apply.)
A. Airline mechanic
B. Client with Down syndrome
C. Drummer in a rock band
D. Teenager listening to music using ear buds
E. Telephone operator
All
Most people with Down syndrome develop hearing loss as adults.
Clients who regularly use devices inserted into the ear, such as headsets, place them at high risk for hearing problems.
Electronystagmography is a test that is sensitive for detecting ...
central and peripheral disease of the vestibular system in the ear
The older adult client reports ear pain. Otoscopic examination by the nurse practitioner (NP) reveals a dull and retracted membrane. What does the NP do next?
C. Tests hearing acuity
The nurse is assessing the client with recent changes in hearing. After taking a medication history, which drugs does the nurse identify as possible causes of the client's hearing change? (Select all that apply.)
A. Acetaminophen
B. Beta blockers
C. Erythromycin
D. Ibuprofen
E. Insulin
F. Lasix
C, D and F
Many:
antibiotics
diruretics
NSAIDs
Chemos
Carbamazepine
Quinine
Quinidine
A 23-year-old woman is being treated for chronic otitis media in the right ear. She rates her pain as 8 on a scale of 1 to 10. She also has decreased hearing in the affected ear and a sensation of fullness. Although she is prescribed an oral antibiotic, she tells you that she does not want to get the prescription filled and asks if she can be treated with eardrops.
What are potential problems associated with untreated otitis media?
If otitis progresses or remains untreated, permanent conductive hearing loss may occur. If the eardrum perforates, infective material may cause an external otitis, which can thicken and scar the middle ear if left untreated. Necrosis of the ossicles destroys middle-ear structures.
A 23-year-old woman is being treated for chronic otitis media in the right ear. She rates her pain as 8 on a scale of 1 to 10. She also has decreased hearing in the affected ear and a sensation of fullness. Although she is prescribed an oral antibiotic, she tells you that she does not want to get the prescription filled and asks if she can be treated with eardrops.
How can pain associated with otitis media be controlled?
Pain rated as “8” on a scale of 1 to 10 may require opioid analgesics for relief. Other nonpharmacologic measures can be used to further reduce pain. Suggest bedrest, because bedrest limits head movements that intensify the pain. Heat may be applied with a heating pad adjusted to a low setting. Application of cold may also relieve the pain. Check with the health care provider about antihistamines and decongestants. These are prescribed to decrease mucus production and to decrease fluid in the middle ear. The body can then reabsorb the fluid, reducing pressure and pain.
A 23-year-old woman is being treated for chronic otitis media in the right ear. She rates her pain as 8 on a scale of 1 to 10. She also has decreased hearing in the affected ear and a sensation of fullness. Although she is prescribed an oral antibiotic, she tells you that she does not want to get the prescription filled and asks if she can be treated with eardrops.
How would you answer the patient’s question regarding treatment with eardrops?
Topical antibiotics are not used to treat otitis media because they do not reach the site of infection. It is important for the patient to take medication as prescribed because chronic otitis media can cause middle-ear injury. In addition to treating the infective organism, systemic antibiotic therapy decreases pain by reducing inflammation.
Which is the priority nursing diagnosis for a client with Ménière’s disease during an attack?
D. Risk for Injury
The vertigo is severe with the sensation of whirling and complete loss of balance and sense position that can cause the patient to fall (even from a sitting position). The vertigo is so intense that even while lying down, the patient often holds the bed or ground to prevent the whirling sensation. The vertigo can last 3 to 4 hours, and the patient may remain dizzy for an additional 12 hours after the vertigo is gone. While vertigo and dizziness remain, the patient is at risk for injury from falls.
The 53-year-old patient is visiting the ENT clinic today. She has had progressive hearing loss since her late 20s. Her ability to hear is better with her right ear, and she has been using bilateral hearing aids for the past 5 years. After being evaluated, it is determined that she has otosclerosis. She discusses options with her physician and the decision is made for her to have a stapedectomy of the left ear.
Why is the procedure done on the left ear rather than the right ear?
Even though the success rate of this procedure is high, there is always a risk of failure that might lead to total deafness on the affected side. Therefore, because her hearing is better in the right ear, the procedure will be done on the ear that is most affected in case of complications.
otosclerosis
abnormal growth of bone near the middle ear. It can result in hearing loss. It is more common in women.
stapedectomy
a surgical procedure of the middle ear performed to improve hearing. If the stapes footplate is fixed in position, rather than being normallymobile, then a conductive hearing loss results. There are two major causes of stapes fixation. The first is a disease process of abnormal mineralization of the temporal bone called otosclerosis. The second is a congenital malformation of the stapes.
Situation: Your patient is a 74-year-old man with a history of diabetes and hypertension. He had an upper respiratory infection and is now complaining of pain in his left ear and decreased ability to hear. Otitis media is diagnosed. What medication might be prescribed if he complained of disequilibrium?
A. Meclizine hydrochloride (Antivert)
Many ear disorders disturb equilibrium. Antivertiginous drugs can help correct dizziness.
Situation: Your patient is a 74-year-old man with a history of diabetes and hypertension. He had an upper respiratory infection and is now complaining of pain in his left ear and decreased ability to hear. Otitis media is diagnosed. He has been shown how to instill his eardrops. He is being discharged on an antihistamine and a decongestant. He wants to know why he will need to take these. What is your best response?
B. To decrease mucus production and fluid in the middle ear
Antihistamines and decongestants are prescribed to decrease mucus production and to decrease fluid in the middle ear. The body can then reabsorb the fluid, reducing pressure and pain.
Older patients are especially susceptible to ototoxicity because of ...
reduced kidney function
Situation: Your patient is a 74-year-old man with a history of diabetes and hypertension. He had an upper respiratory infection and is now complaining of pain in his left ear and decreased ability to hear. Otitis media is diagnosed. He will need eardrops. What should your education about instillation of eardrops include? Select all that apply.
A. Check label to ensure correct dosage and time.
B. Place the bottle in warm water for 5 minutes.
C. Tilt head in opposite direction of affected ear.
D. Insert cotton ball as packing.
All
Situation: Your patient is a 40-year-old female with Ménière's disease. She experiences vertigo, nausea, and vomiting on a regular basis. She is surprised at the number of medications she is taking. What medication(s) would you expect to see used in this patient? Select all that apply.
A. Nicotinic acid
B. Dimenhydrinate (Dramamine)
C. Chlorpromazine hydrochloride (Novo-Chlorpromazine)
D. Diazepam (Valium)
All
Drug therapy aims to control the vertigo and vomiting and restore normal balance. Nicotinic acid has been found to be useful because of its vasodilator effect. Antihistamines such as diphenhydramine hydrochloride (Benadryl, Allerdryl) and dimenhydrinate (Dramamine, Gravol) help reduce the severity of or stop an acute attack. Antiemetics such as chlorpromazine hydrochloride (Thorazine, Novo-Chlorpromazine), droperidol (Inapsine), and trimethobenzamide hydrochloride (Arrestin, Tigan) help control the nausea and vomiting. Diazepam (Valium, Apo-Diazepam) calms the patient; controls vertigo, nausea, and vomiting; and allows the patient to rest quietly during an attack.
Four home health patients are scheduled for home visits today. Which patient is best for the home health nurse manager to assign to an LPN/LVN?
C. A patient with vertigo who needs a scopolamine patch (Trans-Derm Scop) applied
Medication administration is within the scope of practice for LPNs/LVNs. The other patients will need teaching or assessments that are appropriate for the RN level of practice.
mastoiditis
result of an infection that extends to the air cells of the skull behind the ear. Specifically, it is an inflammation of the mucosal lining of the mastoid antrum and mastoid air cell system inside the mastoid process. The mastoid process is the portion of the temporal bone of the skull that is behind the ear which contains open, air-containing spaces. Mastoiditis is usually caused by untreated acute otitis media (middle ear infection) and used to be a leading cause of child mortality. With the development of antibiotics, however, mastoiditis has become quite rare in developed countries where surgical treatment is now much less frequent and more conservative, unlike former times.[2] Untreated, the infection can spread to surrounding structures, including the brain, causing serious complications.
Ménière's disease
disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of vertigo, low-pitched tinnitus, and hearing loss. The hearing loss is fluctuating rather than permanent, meaning that it comes and goes, alternating between ears for some time, then becomes permanent with no return to normal function.
acoustic neuroma
is a growth or tumor of nerve tissue. Neuromas tend to be benign (i.e. not cancerous)
The nurse is performing an otoscopic examination of the client's ear and sees a greenish white drainage. What does the nurse do next?
A. Disposes of the otoscope tip and washes his or her hands before examining the other ear
The health care provider will be notified after the ear examination is complete. After an otoscopic examination, the nurse must perform an auditory assessment.
A specimen is obtained only if the nurse is examining the external meatus region, but this is not the first step. The nurse must assess the second ear and compare.
Medications for vertigo may cause AAA. The client should not drive or operate machinery while taking these drugs.
A) drowsiness
Which technique is the correct way to instill eardrops?
C. Placing the medication bottle in a bowl of warm water before instillation
Place the bottle of eardrops (with the top on tightly) in a bowl of warm water for 5 minutes. This warms the medication and makes instillation more comfortable for the client.
The head should be gently moved back and forth five times after installation to ensure proper distribution.
The nurse is teaching the client who will soon be fitted for a hearing aid about the proper care and use. Which statement by the client indicates that teaching was effective?
C. ''Listening to the radio and television will help me get used to new sounds.''
With hearing aids, background noises are amplified. The client must learn to concentrate and filter out background noises.
The client should start using the hearing aid slowly, at first wearing it only at home and only during part of the day.
The cost of smaller hearing aids is more than for larger ones.
Listening to television and the radio and reading aloud can help the client get used to new sounds.
The nurse is teaching the client about audiometric testing. Which statement by the nurse effectively communicates information about the procedure to the client?
B. ''I will sit right in front of you in the soundproof booth and give you instructions on what types of sounds you will hear and how you'll need to respond.''
Pictures help the client with impaired hearing, but the good ear is tested first. The client wears earphones and listens for sounds, not flashing lights.
Earphones are placed on the client. The client will raise her or his hand up when hearing the first sound and lower the hand when the sound first disappears.
The AAA can inform the client about support groups in the area, along with interventions to help improve hearing.
Hearing Loss Association of America
The AAA assists clients in coping with tinnitus when other therapy is unsuccessful.
American Tinnitus Association
Ear mold hearing aids can amplify sounds to AAA the tinnitus during the day.
drown out
The older adult client reports ear pain. To differentiate the cause, which clinical manifestation is more indicative of otitis media?
A. Vertigo
With otitis media, as the pressure on the middle ear pushes against the inner ear, the client may have dizziness or vertigo.
Unlike the pinna, pain on movement of tragus (flap anterior to canal) is indicative of external otitis.
The older adult client reports nausea during the removal of impacted cerumen from the ear canal. What does the nurse do next?
D. Stops irrigation immediately
The client's nausea may be a sign of vertigo. If nausea, vomiting, or dizziness develops in the client, stop the irrigation immediately.
Antiemetics should not be immediately administered in this case. The client's nausea may be a symptom of vertigo and further assessment is required first.
Which type of drug therapy does the nurse anticipate giving to the client with M'ni're's disease to decrease endolymph volume?
A. Diuretics
Antihistamines help reduce the severity of or stop an acute attack, but they do not decrease endolymph volume.
Mild diuretics are prescribed to decrease endolymph volume.
The client is in the immediate postoperative period after tympanoplasty. How does the nurse position the client?
A. With the affected ear facing up
Keep the client flat, with the head turned to the side and the operative ear facing up, for at least 12 hours after surgery.
Raising the head places undue pressure on the surgical site.
The nurse is reviewing postoperative instructions with the client undergoing stapedectomy. Which statement by the client indicates a need for further teaching?
C. ''I will be able to hear as soon as my dressing is removed.''
Hearing is initially worse after a stapedectomy. Inform the client that improvement in hearing may not occur until 6 weeks after surgery. At first, the ear packing interferes with hearing. Swelling in the ear after surgery reduces hearing, but this is temporary.
Vertigo, nausea, and vomiting are common after surgery because of the nearness of the surgical site to inner ear structures.
Clients should not drink through a straw for 2 to 3 weeks after surgery.
Rinne Test for unilateral hearing loss
The Rinne test is performed by placing a high frequency (512 Hz) vibrating tuning fork against the patient's mastoid bone and asking the patient to tell you when the sound is no longer heard. Once they signal they can't hear it, quickly position the still vibrating tuning fork 1–2 cm from the auditory canal, and again ask the patient to tell you if they are able to hear the tuning fork.
Normal Hearing: Air conduction should be greater than bone conduction and so the patient should be able to hear the tuning fork next to the pinna after they can no longer hear it when held against the mastoid.
Abnormal Hearing:If they are not able to hear the tuning fork after mastoid test, it means that their bone conduction is greater than their air conduction. This indicates there is something inhibiting the passage of sound waves from the ear canal, through the middle ear apparatus and into the cochlea (i.e., there is a conductive hearing loss).
In sensorineural hearing loss the ability to sense the tuning fork by both bone and air conduction is equally diminished. Sensorineurally hearing loss patients usually can hear better on the mastoid process than air process, but indicate the sound has stopped much earlier than conductive loss patients.
Author
TomWruble
ID
245769
Card Set
NUR 216 E2
Description
assessment and care of eye/vision and ears/hearing (plus stuff that should have been on the previous exam, but instead included material from the first quiz - whoha!)
