1114 Test 2 Review

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  1. Know the age related changes that occur and what type of skin lesions you could find on an older patient.
    • Wrinkling of the skin occurs as a result of thinning of the skin layers and degeneration of elastin fibers.
    • A loss of elasticity and strength occurs.
    • Sweat glands decrease in size and number.
    • Production of sebum decreases and becomes more apparent earlier in women than in men.
    • Dryness and pruritus are common.
    • Skin becomes paler because the number of melanin cells decrease.
    • Lentigines: pigmented spots on sun-exposed areas, often called liver spots although they have nothing to do with the liver.
    • Senile purpura: large, purplish bruises that resolve very slowly.
    • Senile angiomas: bright-red papules
    • Seborrheic keratoses: waxy, raised lesions, often flesh colored to dark brown or black and vary in size.
    • Acrochordons (skin tags): small, soft, raised lesions often flesh colored or pigmented.
    • Risk of premalignant and malignant skin lesions increases with age.
    • Most men are bald by age 80.
    • Scalp hair thins in women.
    • Increased facial hair in men and women.
    • Men have increased hair in the nares, eyebrows, or helix of the ear.
    • Nails flatten and become dry, brittle, and discolored.
  2. Know why a functional assessment can provide important clues in the skin assessment and what type of things would be included in a functional assessment.
    • Skin is inspected with attention to the color and variations in pigmentation.
    • Document dilated blood vessels and angiomas.
    • Carefully inspect nevi for irregularities in shape, pigmentation, and ulcerations or changes in surrounding skin.
    • Palpate nevi for tenderness and measure in centimeters.
    • Describe the location, distribution, and characteristics of any rashes.
    • Not color, amount, and odor of any drainage.
    • Palpate skin to collect data about temperature, moisture, texture, thickness, edema, mobility and turgor.
    • Dark skin has a reddish undertone. A grayish undertone may reflect cyanosis, which is best seen around the mouth, over the cheekbones, and on the earlobes. Inflammation may be better detected by areas of abnormal warmth and firmness than by color changes. Rashes are better seen by shining a light at an angle to reveal irregularities in skin surface.
    • Inspect the hair for color, distribution and oiliness and palpate to determine texture.
    • Inspect scalp for scaliness, infestations, and lesions.
    • Note the shape and contour of  fingernails and toe nails
    • Note the color of the nail bed.
    • Check capillary refill (color should return in 3-5 seconds) and watch for clubbing of the nails.
  3. Know what diseases, bacteria, fungi, virus etc.that causes the skin lesions
    • Impetigo: Cause: Group A streptococci Signs and symptoms: vesicle or pustule that ruptures, leaving a thick crust Treatment: antibiotic therapy, erythromycin or dicloxacillin
    • Folliculitis: Cause: Staphylococcus aureus Signs and symptoms: inflamed hair follicles with white pustules Treatment: warm compresses, topical antibiotic agents
    • Furuncle (boil) Cause: Staphylococcus aureus Signs and symptoms: inflamed skin and subcutaneous tissue with deep, inflamed nodules Treatment: warm compresses, topical antibiotic agents
    • Carbuncle: Cause: Staphylococcus aureus Signs and symptoms: clustered, interconnected furuncles Treatment: systemic antibiotic agents, incision and drainage
    • Erysipelas: Cause: Beta-hemolytic group A streptococci Signs and symptoms: round or oval patches that enlarge and spread; redness, swelling, tenderness, warmth Treatment: systemic antibiotic agents, usually penicillin
    • Cellulitis Cause: Usually Streptococcus pyogenes Signs and symptoms: local tenderness and redness at first, then malaise, chills and fever; site becomes more erythematous; nodules and vesicles may form; vesicles may rupture, releasing purulent material identified by culture Treatment: For S. pyogenes, penicillin, a cephalosporin agent, or vancomycin; other antibiotic agents for other organisms
    • Verruca (wart) Cause: Human papillomavirus Signs and symptoms: at first, small shiny lesions; they enlarge and become rough Treatment: electrical current to destroy lesion followed by removal with curette, cryotherapy (freezing), topical medications
  4. Know Atopic dermatitis (Eczema) and the signs and symptoms of this disorder. Know what we can teach the patient to help with comfort.
    • Is one of the several disorders referred to as eczema it has 3 stages.
    • Acute stage is when it is red, oozing, crusty, rash and intense pruritus.
    • Manifestation of the subacute stage includes redness, excoriation, and scaling plaques or pustules. Fine skin may give a silvery appearance.
    • Chronic stage, the skin becomes dry, thickened and scaly and brownish-gray in color. Open lesions invite infection and scarring may occur.
  5. Know what we should do as a nurse to support the family.
     We need to teach the family and the patients that have atopic dermatitis have a personal history of asthma, hay fever, eczema, or food allergies. Medical diagnosis is totally based on the health history and the physical examination. Other procedures may be done like skin biopsy, serum immunoglobin E levels and culture to diagnose the second infection.Teach the patient not to irritation to the skin examples: i.      New soaps keep room at 68F to 75 F with 44% to 55% humidity, wash all new clothing before wearing it, mild detergents should be used and all closed rinsed twice. ii.      You can decrease the itching by moisturizing the skin to help maintain the skin integrity. iii.      Any break down in the skin presents the pathogens inspect the skin and report any new lesions.
  6. Know Seborrheic Dermatitis the signs and symptoms of this disorder and medical treatments.
    • This is a chronic inflammatory disease of the skin.  Affects the scalp, eyebrows, eyelids, lips, ears, sternal area under the breast and the axillary, umbilical groin gluteal crease, when in the scalp this is known by dandruff. Anyone with this may have thick crust thin powdered scales or oily patches. Scales maybe yellowish or reddish. Cause of this is unknown it seems to be aggravated with emotional stress and neurologic disease. Medical diagnosis is based on health history.
    • MEDICAL TREATMENT  i.      Use topical ketoconazole (nizoral) sometimes with topical steroids agents. ii.      treated with medical shampoo's use two to three times a week, shampoos need to contain selenium sulfide (Selsun), ketoconazole, tar, zinc pyrithione, salicylicacid 
    • Nurses treatment   i.      Explain the conditions, reinforce the physician’s instruction for the treatment discusses the patients concerns and provide ways to help with the pruritus. ii.      Help patient with their concerns.
  7. Know Psoriasis. Know the signs and symptoms of this disorder. Know what signs and symptoms we should tell the patient and family to report.
    Psoriasis is an inflammatory disorder characterized by abnormal proliferation of skin cells.  The classic sign of psoriasis is the appearance of bright red lesions that may be covered with silvery scales. It is caused by rapid proliferation of epidermal cells.  It is usually chronic with cycles of exacerbations and remissions.  Multiple factors acting on a genetically predisposed person are thought to cause this disorder. It is usually chronic with cycles of exacerbations and remissions.  Factors that aggravate psoriasis are stress, strep, overuse of alcohol, and drugs, such as lithium and beta blocker agents.  Tell patient to report signs of secondary infection (i.e., fever, purulent discharge, increased redness) to the physician.  Encourage adequate rest, good nutrition, and stress management.
  8. Know Intertrigo. Know the signs and symptoms of this disorder and what type environment contributes to yeast or bacteria to grow.
    Intertrigo is inflammation of the skin where two skin surfaces touch axillae, abdominal skin folds, and the area under the breasts.  The affected area is usually red and weeping with clear margins.  The area may be surrounded by vesicles and pustules.  It results from heat, friction, and moisture between two touching body surfaces.  These factors create the perfect environment for infection by Candida albicans (yeast) or bacteria.   It is fairly common among patients in long term care facilities.  Investigate complaints of pain irritation, or redness in body folds.  Monitor body temperature to detect possible infection.  Inspect susceptible areas (i.e., axillae, groin, beneath breasts, abdominal skin folds) on daily basis.
  9. Know Acne. Know what medications are used to treat acne and important information to be taught to patient who is taking medications.
    Acne affects the hair follicles and sebaceous glands.  It is characterized by comedones (whiteheads and blackheads), pustules, and cysts.  Most often develops on the face, neck, and upper trunk.  Usually begins in adolescence and may last into adulthood.  Acne develops when androgenic hormones cause increased sebum production and bacteria (propionibacterium acnes) proliferate, causing sebaceous follicles to become blocked and inflamed.  Acne it can be triggered by high levels of progestin in birth control pill, oil based cosmetics, high doses of corticosteroid agents, hormonal changes associated with the menstrual period, and some endocrine disorders. NOT caused by fatty foods, chocolate or poor hygiene.  There are many different medications. If all meds have been tried with little success, Isotretinoin (Accutane) is prescribed as the last resort.  It can cause mental depression, possibly leading to suicidal ideation.  If depression develops, the physician should immediately be called to have the drug discontinued.  It can cause severe fetal deformities.  Therefore women who take the drug must prevent pregnancy until at least 1 month after therapy has been completed.  Discourage picking or squeezing lesions because it may force infected material deeper into the follicle.  Advise the pt that harsh cleansers and vigorous scrubbing have no therapeutic value.
  10. Know Herpes Simplex. Know the difference between HSV type I and HSV type 2. Know the signs and symptoms of each. Know the patient teaching that should be done.
    • Cause and Risk Factors  i.      Infection that begins with itching and burning and progresses to the development of vesicles that rupture and form crusts. ii.      Sites most infected are nose, lips, cheeks, ears, and genitalia.  iii.      Oral lesions are commonly called cold sores or fever blisters. iv.      HSV-1 are infections on the face and upper body   v.      HSV-2 infections are usually on the genitals   vi.      Both types may cause oral or genital infections.
    • Medical Diagnosis   i.      Laboratory studies of exudate from a lesion and blood studies to detect specific antibodies.
    • Medical Treatment    i.      Oral acyclovir is more effective than the topical preparation for initial and recurrent infections.
    • Nursing Care of Herpes Simplex   i.      Condition is contagious and tends to recur.
    • Interventions  i.      Ineffective Self-Health Management  1.      Stress that HSV remains in a dormant state in the body after the initial infection.  2.      Emotion distress, fever, trauma, sunburn or fatigues are expected.   ii.      Avoid oral contact while lesions are present.   iii.      Exercise good hand washing and avoid touching the lesions.
  11. Know Herpes Zoster. Know the signs and symptoms of this disorder.
    • Cause and Risk Factors    i.      Caused by the varicella-zoster virus    ii.      First symptoms are pain, itching, and heightened sensitivity along a nerve pathway, followed by the formation of vesicles.    iii.      Crusts form when skin is affected.   iv.      Ulcers may develop when mucous membranes are affected.  v.      Contagious to people who have not had previous exposure to the virus.   vi.      Complications that may occur are postherpetic neuralgia, trigeminal herpes zoster, and ophthalmic involvement.
    • Medical Diagnosis   i.      Confirmed by a Tzanck smear or viral culture of material from a lesion
    • Medical Treatment  i.      Acyclovir, famciclovir, valacyclovir, and foscarnet   ii.      Individuals 60 years and older receive a vaccine for herpes zoster
    • Nursing Care    i.      Complete medical history is needed to identify conditions or treatments.
    • Interventions   i.      Impaired Skin Integrity  1.      Apply cool medication compresses and administer antipruritic agents as ordered.    ii.      Acute Pain  1.      Administer prescribed analgesic agents and antiviral medications and instruct in self-medication   iii.      Ineffective Coping  1.      Emotional support  2.      Advise the patient that the condition is communicable to people who have never been exposed to chickenpox.
  12. Know what Necrotizing fasciitis is
    • Infection of the deep fascial structures under the skin
    • Organisms excrete enzymes that destroy tissue, including blood vessels that supply the affected area.
    • Deprived of blood flow, tissue necrosis occurs.
    • Treatment involves extensive debridement, intravenous and topical antibiotic agents, and eventual skin grafting.
  13. Know what conditions are treated with plastic surgery and teaching that needs to be given to the patient before surgery and what post op care can be done.
    Aesthetic surgical procedures are performed to improve appearance, whereas reconstructive procedures are done to correct abnormalities.  i.      Rhytidectomy: Commonly called a face lift ii.      Blepharoplasty: Removal of excess tissue around the eyes   iii.      Chin implants: Placing a prosthesis to correct a receding chin   iv.      Rhinoplasty: Alters the shape or size, or both, of the nose    v.      Abdominoplasty: Excess skin and adipose tissue are removed and the abdominal muscles are tightened.  vi.      Breast augmentation: Breast enlargement      vii.      Breast reduction: Decreases breast size and maybe requested to improve appearance, body proportion, or to eliminate discomfort associated with excessively large breasts.   viii.      Liposuction: Removal of excess adipose tissue, most commonly used on the thighs, abdomen, arms, and buttocks.   ix.      Preoperative Nursing Care: Emphasizes teaching for self-care.  2.      Initial teaching done by the physician, office nurse or staff nurse
  14. Know what Dr. Graf said about actions for chemical spill in the eye.
    • Acid precipitates quickly
    • Alkaline continues to penetrate  i.      Therefore can progress over an extended period of time
    • Management   i.    Continuous irrigation with saline until neutral pH
  15. Know about Glaucoma
    • Glaucoma is one of the leading causes of blindness in the United States.b.      Is
    • a condition in which intraocular pressure is increased beyond normal. c.       Excess pressure damages the back portion of the eye. It impairs blood flow to the optic nerve and retina, resulting in vision impairment.d.      Peripheral vision is lost firste.       TYPES of GLAUCOMA                                                               i.      Primary open angle                                                            ii.      Low tension                                                          iii.      Primary angle closure                                                          iv.      Secondary glaucoma’s1.      Steroid induced 2.      Traumatic3.      Pigmentary Dispersion Syndrome4.      Pseudoexfoliation syndrome5.      Neovascular f.       Pachymetry – ultrasound measuring device to calculate corneal thickness to determine true IOP.g.      Gonioscopy – measurement of angle where aqueous fluid drainage occurs
  16. 1.      Know about the Snellen’s test
    a.       Chart that has rows of progressively smaller letters. From a distance of 20 feet, the patient is instructed to read down the chart until more than two mistakes are made on a single line. Each eye is tested separately and then together. The lines are numbered 20 over 200, 100, 70, 50, 40, 30, 25, 20 and 15.b.      20/30: this means that the person could read at 20 feet what a person with normal vision could read at 30 feet.
  17. Know about Ophthalmoscopic exam
    a.       An ophthalmoscope is an instrument used to exam the retina and vitreous.b.      Ophthalmoscopy requires dilating the pupils with drops to give the doctor the best view inside they eye.c.       It examines the lens, vitreous humor retina, and optic disc.  
  18. 1.      Know about topical meds
    a.       Mydriatic agents dilate the pupilsb.      Miotic agents constrict the pupilsc.       Cycloplegic agents prevent accommodation
  19. 1.      Know what a nurse must or be aware of after surgeries.
    a.       Check patient's vital signs and level of consciousness during recovery from anesthesiab.      Ask patient about comfort, including pain and nauseac.       Determine patient's understanding of and ability to administer medications at home
  20. 1.      Know about blepharitis
    a.       An inflammation of the hair follicles along the eyelid margin. b.      It can be caused by bacteria, most often by staphylococci.   Seborrheic blepharitis is often found with seborrhea of the scalp and eyebrows. c.       Symptoms include itching, burning, and photophobia.  Scales or crusts may be seen on the lid margins.  The patient may complain that the eyelids are sealed shut by died crusts on awakening.  d.      Untreated blepharitis could lead to inflammation of the cornea or hordeolum.  e.       The physician may prescribe an antibiotic ointment for the condition, be certain that the medication applied to the eyes is an ophthalmic preparation.  The eyelids also can be gently cleansed with baby shampoo solution
  21. 1.      Know about hordeolum
    a.       Also know as a styeb.      It’s a common acute staphylococcal infection of the eyelid margin that originates in the lash follicle.  The affected area of the lid is read, swollen, and tender. c.       Treatment is the application of warm, moist compresses several times a day.  If a person repeated infections, then these may be related to staphylococcal infections at some other location of the body.  The physician attempts to locate any other infections and may order Hyrdeolum treated with ophthalmic antibiotic agents.
  22. Know the post op care for corneal transplants andmost surgeries
    a.       Keratoplast (Corneal transplants)b.      For all eye surgeries inspect the dressing for drainage and ask if the patient is having any pain or nausea.  After the dressing is removed, inspect the eye for corneal opacity.  In addition, evaluate the patient's visual acuity.  It’s common for vision to be blurry the first few weeks followed by gradual improvement.  Complete healing may take as long as 6 months. c.       Specific care after keratoplasty Caution the patient to avoid any activities that increase pressure in the eye, including rubbing they eye, bending forward, lifting, straining and stool, and coughing.  Report any promptly treat nausea because vomiting raises intraocular pressure. Administer stool softeners as ordered to prevent constipation.  The patient probably will be instructed to wear the shield for several weeks while sleeping to prevent accidental trauma. 
  23. 1.      Know about Retina tears
    a.       Retinal detachment is a separation of the sensory layer of the eyeball from the pigmented layer.  It begins when a tear in the retina allows fluid to collect between the sensory and pigmented layers.  The fluid causes the two layers to separate.  Separation deprives the sensory layers of nutrients and O2 that normally are supplied by the blood vessels in the choroid.  This leads to damage to the nerve tissue in the sensory layer and resultant partial or complete loss of vision. Retinal tears may occur spontaneously or as a result of drama.  They are more common in older people and in people with myopia.  b.      Signs and symptoms of retinal detachment depend on the location and extent of the detachment. Patients may report seeing flashes of light or floaters. Vision may be cloudy.  If the area of detachment is large, then vision may be lost completely.  Some patients say it seems as if a curtain has come down or acres the line of vision.  This is very frightening to the patient.  c.       Medical and surgical treatment… special procedures are required to repair retinal detachments.  Most holes or tears must be sealed promptly.  Laser photocoagulation is one method commonly used to do this.  As the area heals, scar tissue forms that seals the tear.  Cryotherapy also causes scar tissue to form, but it uses a cold probe applied to the eyeball behind the tear.  The cold radiates through the layers of tissue, freezing the torn tissue. Another procedure that may be used is retinopexy, in which gas is injected into the eye to apply pressure to the tear.
  24. 1.      Know about Refactory errors
    • a.       Occur when refractive media do not bend light rays correctly.b.      Myopia                                                             
    • i.      Nearsightedness                                                            ii.      The lens is situated too far from retina, and light rays focus in front of the retinac.       Hyperopia                                                              i.      Farsightedness                                                            ii.      Convex lenses are needed for correctiond.      Astigmatism                                                              i.      Irregularities in the cornea or lens
  25. 1.      Know about hearing lost and types
    a.       Types of Hearing Loss                                                              i.      Conductive hearing loss1.      Interference with the transmission of sound waves2.      Obstruction of the external canal or eustachian tube and otosclerosis3.      Most are treatable                                                            ii.      Sensorineural1.      Nerve deafness2.      Disturbance of the neural structures in the inner ear or nerve pathways to the brain3.      May be congenital, caused by noise, trauma, aging, Meniere disease, ototoxicity, diabetes and syphilis                                                          iii.      Mixed1.      Combination of conductive and sensorineural loss                                                          iv.      Central1.      Due to some problem in the CNS2.      Cannot perceive or interpret sounds that are
  26. 1.      Know what Triggers vertigo and what we should advice our patients.
    a.       The sensation that one's body or the room is spinningb.      Trigged by sudden movements, so patient should move slowly and carefullyc.       Instruct patient to call for helpd.      Assist as long as dizziness is a probleme.       Raise side rails and leave the bed in low position 
  27. 1.      Know the interventions for Patients with impaired hearing. Know the guidelines we should follow for the hearing impaired.
    a.       Impaired Verbal Communication                                                              i.      Effective communication: patient and others use alternative means of communicationb.      Social Isolation                                                              i.      Have a positive attitude                                                            ii.      Encourage to learn new communication methods and use of assistive devices                                                          iii.      Counseling may be suggested if patient becomes increasingly withdrawn and sadc.       Ineffective Coping                                                              i.      Denial, anxiousd.      Deficient Knowledge                                                              i.      Reduce the risk of additional impairment                                                            ii.      Advise patient to seek prompt treatment of infection such as fever, pain in the ear, drainage                                                          iii.      If taking ototoxic drugs, contact physician if hearing acuity worsens or tinnitus develops.                                                          iv.      Instruct on the use of hearing aids
  28. 1.      Know the Rinne test and the Weber test and what they test for. Also know which way the sound is conducted with each of these test.
    a.       Rinne test                                                              i.      Hit tuning fork on the hand and place the base of the tuning fork on the patient's mastoid bone. Patient will hear a humming sound through the bone. When sound is no longer heard, move the fork near the ear canal.                                                            ii.      Assess the patient's ability to hear sounds waves conducted through the air                                                          iii.      Air conduction is better than bone conductionb.      Weber test                                                              i.      Place the base of the activated tuning fork on the midline of the skill and have patient identify the side in which the sound is loudest.                                                            ii.      Normal hearing in both ears, the sound is equal on each side.                                                          iii.      Sound louder in an ear with conductive hearing loss and softer in an ear with sensorineural loss
  29. 1.      Know what changes occur with age with your hearing.
    a.       Skin of the auricle becomes dry and wrinkledb.      Cerumen production declines and protective wax is drierc.       Hairs in the canal become coarser and longer, especially in mend.      Eardrum thickens and bony joints in the middle ear degeneratee.       Degenerative changes include atrophy of the cochlea, the cochlear nerve cells, and the organ of Corti
  30. 1.      Know the anatomy of the ear (External ear, Middle ear & Inner ear) Know the function of each area.
    a.       External Ear                                                              i.      Auricle1.      Also called the pinna, is the visible part of the ear                                                            ii.      Innervation1.      Pain in the ear can be traced to disorders of the nose, mouth, or beck.2.      7th cranial nerve lies alongside the auditory canal                                                          iii.      Lymph Drainage1.      Lymph nodes in front of, behind, and below the auricle2.      Become enlarged when patient has an ear infection                                                          iv.      External Auditory Canal1.      Extends from the external opening to the tympanic membrane2.      Canal is lined with cells that secrete cerumen3.      Waxy secretion coats and protects the canal                                                            v.      Tympanic Membrane1.      At the end of the external auditory canal.2.      Shiny and pearl gray3.      Sound waves cause the membrane to vibrateb.      Middle Ear                                                              i.      Bones1.      Inside an air-filled space in the temporal bone2.      Contains 3 small bonesa.       Malleusb.      Incusc.       Stapes3.      Function of the bones is to forward sound waves transmitted by the tympanic membrane to the inner ear.                                                            ii.      Eustachian Tube1.      Extends from the middle ear to the nasopharynx                                                          iii.      Mastoid Process1.      Bony structure behind the auricle.2.      Made up of air cells that connect to the middle ear.3.      Very close to the brain.c.       Inner Ear                                                              i.      Consists of membranous labyrinth and bony labyrinth                                                            ii.      Membranous labyrinth contains fluid called endolymph that moves with changes in body position                                                          iii.      Parts of bony labyrinth are vestibule, semicircular canals, and cochlea                                                          iv.      Oval window opens into the vestibule
  31. Know the nursing assessment for the external ear,hearing and balance. What questions are important to ask in the patient’s history?
    a.       External ear assessment                                                              i.      The position of the auricles is significant. Normally the top of the auricle is an approximately the level of the eye. The ears should be positioned symmetrically. The auricles should be examined for shape, lesions and nodules. The auricles and the mastoid process palpated for tenderness. Palpation in front of, below and behind the ear may locate enlarged lymph nodes.b.       Hearing and balance                                                              i.      Acute conditions that may affect hearing or balance include sinus infections, dental problems, allergies and upper respiratory infections.c.       Patients history                                                               i.      Ask about any previous acute or chronic ear problems. Acute conditions that may affect hearing or balance include sinus infections, dental problems, allergies and upper respiratory infections. Chronic conditions that may be significant are hypertension, diabetes mellitus and hypothyroidism.                                                            ii.      It is significant to note whether female patients have had rubella or have been immunized for the infection.                                                          iii.      The medication history is important to identify any drugs taken that might be ototoxic. The term ototoxic means a drug can damage the eighth cranial nerve or the organs of hearing and balance. Examples of drugs that can have ototoxic effects are aspirin and aminoglycoside antibiotics.
  32. Know the postoperative care for ear surgery and theinterventions. Know why after ear surgery the patient at risk for injury.
    a.       Post operative care                                                              i.      In postoperative period, pain, nausea, dizziness, and fever are common                                                            ii.      Inspect the wound dressing for drainage                                                          iii.      Document drainage color, odor and amountb.      Interventions                                                              i.      Acute pain                                                            ii.      Risk for injury                                                           iii.      Risk for infection                                                          iv.      Disturbed sensory perceptionc.       Risk for injury                                                              i.      Dizziness and vertigo are common after surgery on the ear. Dizziness is a feeling of unsteadiness, whereas vertigo is the sensation that one’s body of the room is spinning.                                                             ii.      Vertigo is often triggered by sudden movements, so advise the patient to move slowly and carefully instruct the patient to call for help when getting up the first few times. Assist the patient as long as dizziness is a problem. Raise side rails, and leave the bed in low position.                                                           iii.      The ear is commonly packed and covered with a dressing. A drain may be in place; only the physician can remove the packing. A specific position may be ordered after surgery. If drainage is being encouraged, then the patient is most likely positioned on the affected side. However, if the procedure includes a graft on the tympanic membrane, then the patient is usually positioned on the unaffected side                                                          iv.      The patient should avoid nose blowing, coughing, and sneezing; however if these are unavoidable, the mouth should be kept open to relieve pressure. Stool softeners any be ordered to prevent constipation and straining.
  33. Know the three different types of hearing lossesand what causes each the hearing loss. Know what hearing aids work with the differenttypes of hearing loss.
    a.       Conductive hearing loss                                                              i.      Interference with the transmission of sound waves from the external or middle ear to the inner ear1.      Factors that may cause conductive hearing loss include obstruction of the external canal or Eustachian tube and otosclerosis. Otosclerosis is a condition in which the stapes in the middle ear does not vibrate2.      Patients who have conductive hearing loss hear better in noisy settings than in quiet settings3.      Most conditions that cause conductive hearing loss are treatable. Obstructions usually can be removed. Otosclerosis can be treated surgically with a procedure call a stapedectormy b.      Sensorineural hearing loss                                                              i.      Disturbance of the neural structures in the inner ear or the nerve pathways to the brain1.      Is also called nerve deafness. 2.      May be congenital, but it also can be caused by noise, trauma, aging, Meniere disease, ototoxicity, diabetes and syphilis3.      Patients with Sensorineural hearing loss can hear sounds but have difficulty understanding speech.c.       Mixed hearing loss                                                              i.      A combination of conductive and Sensorineural losses1.      Treatment of any reversible problems often results in improvement of mixed hearing lossd.      Central hearing loss                                                              i.      Problem in the central nervous system1.      The patient either cannot perceive or cannot interpret sounds that are heard
  34. Know what type of education needs to be done forthe patient with an infection.
    a.       Advise the patient to avoid crowds and people with colds for several weeks. The ear canal should be dept dry for 2 to 4 weeks as instructed by the physician. Shampooing usually is not allowed for 2 weeks, although it is restricted longer in some cases.
  35. Know about otosclerosis.
    a.       Otosclerosis is a hereditary condition in which an abnormal growth causes the foot plate of the stapes to become fixed. The fixed stapes cannot vibrate, so sound waves cannot be transmitted to the inner ear. Conductive hearing loss. b.      Otosclerosis is most common in young Caucasian women.c.       Signs and symptoms                                                              i.      Primary symptoms are slowly progressive hearing loss in the absence of infection.                                                            ii.      In the early stages, patient may report tinnitus.                                                          iii.      The Rinne test reveals bone conduction to be greater than air conduction.d.      Medical treatment                                                              i.      Most common treatment is a surgical procedure call stapedectormy                                                            ii.      Physician advises the patient of the surgical risks, including complete hearing loss, infection, prolonged vertigo and damage to the facial nerve                                                          iii.      Stapedectormy is done under local anesthesia                                                          iv.      The stapes is removed and replaced with a prosthesis                                                            v.      After surgery, bed rest may be ordered for several days; drugs are prescribed to control nausea and back or the unaffected side, but specific position restrictions may be ordered.
  36. Know about labyrinthitis.
    a.       Labyrinthitis is inflammation of the labyrinth. It may be acute or chronic.                                                              i.      Acute labyrinthitis usually follows an acute upper respiratory infection, acute Otitis media, pneumonia, or influenza. It also can be an adverse effect of drugsb.      One type of labyrinthitis is suppurative labyrinthitis.                                                              i.      It is an inner ear infection that usually follows an upper respiratory infection, ear infection or ear surgery. The effects can destroy the labyrinth and cochlea causing permanent deafnessc.       SIGNS AND SYMPTOMS                                                              i.      Vertigo, nausea, vomiting, headache, anorexia, Nystagmus, and Sensorineural hearing loss on the affected sided.      MEDICAL TREATMENT                                                              i.      Antiemetics and supportive care until it resolves                                                            ii.      Antibiotics if infection is present e.       NURSING CARE                                                              i.      Assess symptoms                                                            ii.      Monitor intake and output, daily weights if possible, and food intake if persistent vomiting                                                          iii.      Assist/supervise the patient when out of bed                                                          iv.      Give Antiemetics as prescribed
  37. 1.      Know about different medications that are used for hearing disorders.
    • Antibiotics·Chloramphenicol (Chloromycetin Otic) Use/ActionBroad spectrum antibiotic used to treat infections of lining of external auditory canal Side Effect: Hypersensitivity:   redness, rash, swelling, burning, pain Nuring Intervention: If patient   shows signs of hypersensitivity, withhold drug and notify physician
    • Topical Corticosteroids: Cipro HC (ciprofloxacin and hydrocortisone); Ciprodex ciprofloxacin and dexamethason; Floxin otic (ofloxacin alone) Use/Action: Treat   inflammation, pruritus, and allergic response. Usually   combined with antibacterial or antifungal drug Side Effects: Can encourage   microbial resistance to fluoroquinolones Do not put in   ear if tympanic membrane is perforated. Nursing Interventions: Caution to avoid eye contact
    • Antibacterial   and softening agents: Carbamide peroxide with glycerin (Debrox, Murine   Ear Drops) Use/Action: Soften earwax.   Treat aphthous ulcers. Side Effects: Redness,   irritation, superinfection. Nursing Interventions: Contraindications:   ear surgery, perforated tympanic membrane; ear drainage, redness, pain, or   tenderness. Teach patient not to clean ear with cotton swabs, which force wax   deeper into ear
    • Drying   Agents Boric acid in   isopropyl alcohol (Ear-dry, Swim-ear) Use/Action: Dry external   canal after swimming or bathing. Decrease risk of infection. Side Effects: Local   irritation Nursing Interventions: Instilled in   external canal immediately after swimming or bathing. Contraindicated with   perforated tympanic membrane
    • Antiemetics Scopolamine   (Transderm Scop)Dimenhydrinate   (Dramamine)Meclizine   (Antivert)Chlorpromazine   (Thorazine) Use/Action: Prevent or   treat nausea, vomiting, motion sickness Side Effects: Sedation,   drowsiness, tremor, fever, tachycardia, hypotension, constipation, dry mouth Nursing Interventions: Safety   precautions for drowsiness. Monitor pulse and blood pressure. Monitor stools   and urinary output. Mouth Care
  38. 1.      Know about Ménière disease.
    a.       Ménière disease is a disorder of the labyrinth of the ear related to an accumulation of the fluid in the inner ear.b.      Onset between 30-60 years old.c.       Cause unknown but some things have been found to trigger attacks including: Alcohol, nicotine, stress and certain stimuli including bright lights and sudden movementsd.      Signs and symptoms:                                                              i.      Acute attacks: hearing loss and vertigo accompanied by pallor, sweating, nausea, vomiting, tinnitus; unilaterally. It is heard as a low buzzing sound that sometimes becomes a roar. Some loss of low-frequency sound may remain.e.       Medical diagnosis:                                                               i.      Diagnosis is based on the history and physical findings.                                                            ii.      Audiogram usually reveals a loss of the ability to hear low frequency sounds                                                          iii.      Caloric test or an electronystagmography is done then the patient with the disease has a severe attack of vertigo.                                                          iv.      A glycerol test includes audiometry testing before and after giving a pt oral glycerol, improved hearing after glycerol suggests menieres disease.                                                            v.      Actual diagnosis is done by ruling out diseases with similar symptoms.f.       Medical treatment:                                                              i.      Through drugs such as atropine, epinephrine, benzodiazepine agents such as diazepam (valium), antihistamine agents, antiemetic agents, anticholinergic agents, vasodilator agents, and diuretic agents.                                                            ii.      Low sodium diets seem to increase the length of time between attacks by reducing edema in the inner ear. g.      Surgical treatment:                                                              i.      Surgical procedures work by draining excess fluid from the inner ear or by cutting the part of the acoustic nerve that controls balance.1.      Complications of surgery: infection, hearing loss, loss of cerebrospinal fluid and damage to the seventh cranial nerve (facial nerve).h.      Interventions:                                                              i.      Risk for infection                                                            ii.      Risk for deficient fluid volume                                                          iii.      Anxiety                                                          iv.      Ineffective self-health management
  39. 1.      Know about the key points for a nurse who is irrigating and ear.
    a.       Select the correct solution as ordered by the physicianb.      Warm the solution to body temp (95                         -105 ) c.       Have patient sir up and hold an emesis basin under the eard.      Drape the shoulder under the basine.       Straighten the external canal of an adult by pulling the auricle up and back. For a child, pull the auricle down and backf.       Select an irrigating syringe or bulb syringe with a tip that is smaller than the canal.g.      Direct the solution toward the top of the canal in a steady stream, not toward the eardrum. The procedure can be repeated several times if needed.h.      Sometimes eardrops are ordered to soften the impacted cerumen before irrigatingi.        Describe any substances rinsed out of the ear, if the impacted cerumen or foreign body does not wash out, and then inform the physician.j.        If the tympanic membrane is ruptured, then the canal should not be irrigated because fluid could be forced into the middle ear.
  40. 1.      Know nursing the nursing care that needs to be done for your patient who has had a tonsillectomy.
    a.       Assessment: Postoperative Phase: frequently monitor pt’s responsiveness & vital signs. Usually every 5 minutes until stable, the n every 15 minutes for 1 hour. Then hourly for remainder first 24 postoperative hours. Inspect drainage from mouth or vomited fluid for blood. Blood-tinged drainage is normal at first but should decrease. Note excessive swallowing. Monitor respiratory effort, skin color, pain & dysphagia. b.      Interventions: Decreased Cardiac output, ineffective airway clearance, acute pain, deficient knowledge.
  41. 1.      Know the signs and symptoms that a patient may have that have laryngeal cancer
    a.       Early symptoms: Persistent hoarseness, sore throat, & ear painb.      Late: hemoptysis (blood in sputum), difficulty swallowing or breathing, pain & anorexia leading to weight loss.
  42. 1.      Know about the age related changes in the nose, sinuses and throat.
    a.       Nasal obstruction more common. Softening of ht cartilage of the external nose b.      Mucous membrane, thinner, produces less mucus.c.       Epistaxis: more common in older people d.      Decline in the sense of smell as people age e.       Tissues of larynx: drier and less elastic in older adult f.       Weakened esophageal sphincter: allows gastric contents to flow back into the throat when the pt lies down.
  43. 1.      Know about diagnostic test and procedures and what nursing care needs to be done. Know what medications are given after nasal surgery and why.
    a.      Conditions of nose, sinuses, and throat are diagnosed by cultures, measures of antibodies, & procedure to visualized internal structure. b.      Nursing care: confirm orders & check agency protocol. Tell the pt what to expect. c.       Medications used ·   Topical anesthetics: anesthetic effect on skin and mucous membranes ·   Anti-invectives: kill or suppress growth of microorganisms·   Antipyretics: reduce body temp; used to treat fever. Analgesic effects, Salicylates & other NSAIDs are anti-inflammatory. ·   Opioid analgesics: reduce pain ·   Sympathomimetics (adrenergics): decongestion, vasoconstriction ·   Anticholinergics: decrease salivary & respiratory secretions ·   Antihistamines: block effects of histamine. Used to treat allergic reactions & prevent motion sickness. ·   Antiflammatory drugs: decrease bronchial & nasal inflammation. Decrease mucus production.
  44. 1.      Know about humidification with EENT disorders
    a.       Inspiration of dry air is uncomfortable, because’s loss of body fluid, & can contribute to upper airway infections. Nasal obstruction causes the pt to breathe through the mouth.  b.      Work in one of two ways: by creating an aerosol (dispense tiny droplets of water into the room) or by creating steam (increase humidity by distributing vaporized water). c.       Used sterile distilled water with aerosol units & plain distilled water with steam units. Check & refill regularly. Daily cleaning reduces risk of bacterial contamination. d.      After nasal or sinus surgery bedside room humidifier may be ordered. e.       Pt with a tracheostomy inspires air directly into trachea until airway adjusts. Humidification is essential to prevent excessive drying of the mucosa & secretions.
  45. 1.      Know the different Nursing care interventions for Nasal surgery.
    • a.       Decreased cardiac output: risk of hemorrhage. Advise pt not to blow nose or stain. Laxatives or stool softeners may be ordered.  Pt should not take aspirin. b.      Acute pain: semi or high-fowlers helps control swelling. Analgesic agents & ice packs. Frequent mouth care & oral fluids are soothing. c.       Impaired gas exchange: nasal packing can interfere with breathing. Semi-fowlers with head flat against bed. Humidifier. Frequent oral hygiene. d.      Disturbed body image: Cool compresses may reduce or prevent “black-eyes” which are common.
    • Decreased CardiacOutput related to blood loss from vascular nasal passageways: Normal cardiac output: pulse and BP consistentwith pt norms
    • Acute Pain related to tissuetrauma, edema, or packing: Pain relief: pt states pain reduced, appearsrelaxed
    • Impaired Gas Exchangerelated to airwayobstruction: Adequate gas exchange; respiratory rate &effort & heart rate consistent with pt norms
    • Disturbed Body Image related to facial bruising: Improved body image: pt accepts temporarilyaltered appearance, pt acknowledges that facial discoloration is temporary,resumes normal activities
  46. 1.      Know the anatomy for the nose, sinuses and throat and what each area does.
    a.       External nose: bone, cartilage, & mucous membrane. Upper 1/3 of nose has a bony skeleton, remainder is shaped by cartilage. b.      Internal nose: divided by nasal septum (thin wall that creates two passages), nares (openings on each side of septum), Vestibule (outermost portion, covered by skin that contains nasal hairs). Rest is lined with a mucous membrane. Supplied with blood by branches of internal & external carotids. c.       Layer of mucus covers the membrane. It traps inspired particles & moisturized dry air. Mucus protects airway because it is acidic & contains an enzyme that destroys most bacteria. Cilia sweep particles trapped in mucus toward throat to be swallowed. d.      Olfactory cells line roof of nasal cavity. They are specialized sensory cells that detect odors & relay info to brain. e.       Turbinate’s: folds of tissue on side walls of the internal nose.  They increase the surface area that inspired air crosses. As air swirls over then it is warmed to body temperature. Contain openings through which secretions drain from sinuses.
  47. 1.      Know about the throat culture and how the culture is obtained.
    a.       Isolate & identify organisms. Usually don when streptococcal sore throat is suspected. Can be uses to screen for carries of Neisseria meningitides or diphtheria. b.      A culture specimen should be obtained before starting antibiotic agents. c.       Kits available, they contain sterile swab or applicator & tube of culture medium. d.      Procedure                                                               i.      Good lighting is essential                                                            ii.      Tilt pt’s head back                                                           iii.      Depress tongue with tongue blade.                                                           iv.      Firmly but gently rotate swab over back of throat, tonsils, & any obvious lesion.                                                             v.      Swab shouldn’t touch any other area of mouth.                                                           vi.      Stand to one side or wear a mask because pt usually gag or cough.                                                         vii.      Immediately place swab in tube of culture medium.                                                      viii.      Results are reported in 24-48 hrs. e.       Test can be done to detect antibodies against streptococcus antigens with results in 7-20 minutes.  Page 1265-          Usually done when a streptococcal sore (“strep throat”) is suspected.  -          Kits are available to collect, and contain the specimen. The kit consists of a sterile swab, or applicator, and a tube of culture medium. -          To obtain the specimen good lighting is essential. -          Tilt the patients head back, and depress the tongue with the tongue blade. Firmly, but gently rotate the swab over the back of the throat, tonsils, and any obvious lesion. The swab should not touch any other area of the mouth. Because the patient often gags of cough, stand to one side and wear a mask. Immediately place the swab in the culture medium.
  48. 1.      Know signs and symptoms of sinusitis.
    a.       Pain or a feeling of heaviness over the affected areab.      Purulent drainage from the nose c.       When maxillary sinuses affected, pain may seem like a toothache. d.      Headache is common, especially in the morning. e.       Fever may be present; WBC count may be elevated. f.       Sinusitis is inflammation of the sinuses. g.      Patients with sinusitis usually report pain or a feeling of heaviness over the infected area. They may report purulent drainage from the nose. When the maxillary sinuses are affected, the pain may seem like a toothache. Headache is common. Especially in the morning. Fever may persist, and the white blood cell count may be elevated.
  49. 1.      Know about Acute Viral Coryza (common cold) Know the drug therapy used and not used.
    a.       Caused by any of some 30 viruses b.      Contagious & spread by droplet infection c.       Signs & symptoms                                                              i.      Fever                                                             ii.      Fatigue                                                           iii.      Nasal discharge                                                           iv.      Sore throat d.      Complications                                                               i.      Otitis media                                                            ii.      Sinusitis                                                           iii.      Bronchitis                                                           iv.      Pneumonia   Page 1272·         S/S of Acute Viral Coryza (common cold) usually consists of fever, fatigue, nasal discharge, and sore throat. ·         Drug therapy of the common cold is directed primarily at relief of symptoms and consists of antihistamine agents, and decongestant agents, and anti pyretic agents. ·         Patients often expect to receive antibiotic agents but THEY ARE FOOLS! Antibiotics are NOT effective against infections caused by viruses, like Acute Viral Coryza or the common cold. Duh.
  50. 1.      Know what Epistaxis is, signs and symptoms of it and how it is treated.
    a.       Nosebleed, caused by                                                               i.      Trauma                                                             ii.      Clotting disorders                                                           iii.      Dryness                                                           iv.      Inflammation                                                             v.      Hypertension b.      First aid                                                              i.      Pt should sit down & lean forwards                                                             ii.      Apply direct pressure for 3-5 minutes c.       Medical treatment                                                               i.      Nasal balloon catheter                                                             ii.      Nasal packing d.      Epistaxis is our fancy way of saying NOSEBLEED.e.        When Epistaxis (nosebleeds) occurs, the patient should sit down, and LEAN FOREWARD. Direct pressure should be applied. For 3 to 5 minutes UNLESS THE PATIENT HAS HAD A TRAMATIC INJURY TO THE FACE. ((Facial trauma subjects a nasal fracture, and direct pressure may do more harm.)) An ice pack or a cold compress can be applied to the nose regardless of whether facial trauma has occurred. f.       Treatments for Epistaxis (nosebleeds) include topical vasoconstrictor agents or electrical cautery. If electrical cautery is used the patient, then the patient is given a local anesthetic. – Because honestly, that would hurt like crap. Nasal Balloon Catheters, and Nasal Packing are also used to treat Epistaxis (nosebleeds)
  51. What Christi said we needed to know from CH 53?
    ·         After the Caldwell-Luc procedure, the semi-Fowler position is recommended to prevent swelling & promote drainage·         Antral packing is left in place for 36-72 hours. ·         P 1264 Box 53-1 Assessment of the Nose, Sinuses, & Throat o   Health History §  Chief complaint & history of present illness ·         Nasal discharge, obstruction, bleeding; upper airway symptoms; sneezing, snoring; pain or soreness in the throat or face; change in voice; earache §  Past medical history·         Allergies medications, history of streptococcal infections. §  Review of systems ·         Amount & color of nasal discharge; nasal obstruction; blood in nasal discharge or sputum; sneezing; snoring; throat pain or soreness; hoarseness; earache; altered sense of smell; facial pain o   Physical Examination §  External nose ·         Size, shape, lesions, drainage (color, amount, consistency)§  Abnormal breathing sounds §  Mouth breathing §  Palpation of parenasal sinuses ·         Tenderness, pain §  Patency of nares§  Nasal mucosa ·         Color, drainage, foreign bodies§  Transillumination of sinuses ·         Air, fluid §  Throat ·         Inspection of mucous membranes and tonsils for redness, swelling, drainage, or lesions§  Palpation of neck for enlarged lymph nodes §  Ability to recognize common odors  
Card Set:
1114 Test 2 Review
2012-09-23 23:09:09
Caring Adult

Chapters 50-53
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