What are two types of surgeries and which is more common?
Elective (more common) and emergency
Determination of the presence and extent of pathological condition. Example being lymph node biopsy, bronchoscopy) is known as ____ surgery
Diagnosis
Elimination or repair of a pathological condition. Example being removal of ruptured appendix or benign ovarian cyst is known as ____ surgery
Cure
Alleviation of symptoms without cure. Example- cutting a nerve root to remove symptoms of pain, creating a colostomy me to bypass bowel obstruction is known as ____ surgery
Palliative
_____ surgery is like removal of a more before it becomes malignant, and or removal of a colon in a patient with a family history of colon cancer
Prevention
____ surgery Would be repairing a burn scar, breast reconstruction after mastectomy, cleft palate
Cosmetic
surgical examination to determine the nature or extent of a disease like a laparotomy is ____ surgery
Exploration
same-day admission surgery is known as ____ surgery
Inpatient
Ambulatory surgery is known as _____ surgery
Outpatient
_____ surgeries May be conducted in Endoscopy clinics, physicians office, freestanding surgical clinic's, and outpatient surgery unit in hospitals. Many patients go home with the caregiver within hours of surgery
Ambulatory
The _____ nursing role is to assess knowledge of The disorder requiring surgery, the surgical procedure, diagnostic test/labs
Pre-op
The _____ nurse should assess patients stressors and help relax them
Pre-op
What population is a greater risk when receiving anesthesia ?
Elderly
Obtain past medical history, determine patient expectations, provide/clarify information about procedure, assess stress level are all done in the pre-op ____ ____
Patient interview
Why do we want to reduce anxiety in patients in the pre-op?
High anxiety levels will cause cognitive, decision-making, coping abilities to be reduced
Lack of knowledge of procedure can cause ___ to arise
Anxiety
Pre-op: if you identify your patient is having any ____ a consult with the patients caregiver, a social worker, spiritual advisor, psychologist may be necessary
Fears
What are two types of medications that are usually held before surgery
Herbal and blood thinners
Pre-op when obtaining a history we always want to know family history of ____ or _____ diseases
Heart or endocrine
During the preop stage do you want to ask the patient about any previous .... (2)
Health problems and surgeries
Why do we want to know the liver function before Surgery?
Bc the liver produces clotting factors
Pre-op assessment make sure we know what 3 main things
Cardiac function (EKG), respiratory (Chest x-ray), sleep apnea if any
Pre-op evaluations of ____ functioning Includes assessing the patient's ability to respond to questions, follow commands, and maintain orderly thought patterns
Neurological
For a patient going to have surgery we want to ask them about any recent or chronic ____ ____/ _____
Respiratory diseases or infection
A pt with ____ is especially at rest for adverse effects of anesthesia and surgery
Diabetes
If a pt has ____ we need to document all affected joints before surgery
Arthritis
Who marks surgical site?
Physician
What are 3 main labs drawn for surgery
CBC, HCG (pregnancy test), chemical panel for electrolytes
During the pre-op assessment we want to establish a baseline ____
Baseline vitals
In order for surgical informed consent to be adequate what are three things that the patient has to do
Adequate disclosure (understands risks), understanding/comprehension of information, Has to be voluntary
If a patient is on thyroid medication, and the thyroid function is too high what could happen to the pt (1)
Respiratory problems
In order for blood transfusion to happen pre-op what do we need first
Consent
Pre-op exam is done by a ____ and the role of the ____ is to ensure it's completed and on the chart
Physician; nurse
Pre-op exam should include reviewing results and make sure they are on the chart for ___/_____
Labs/ diagnostic test
If there is abnormal son labs or diagnostic test who should that be communicated to ?
Surgical team
Who requires that all patients admitted to the OR have a documented history and physical in the chart
JACHO
If a patient is on a antiplatelet drugs what test is ordered for pre-op
Coagulation
If a patient is on a diuretic therapy what level when we look at in the pre-op
Potassium
Pre-op teaching has limited time because of....
Pt arriving only hours before surgery
With pre-op patient teaching the _____ information, The patient find out what they will see, hear, smell, field during the surgery. For example you may tell them that the OR will be cold but they can ask for a warm blanket
Sensory
____ information giving in the pre-op would include The patients transferred to holding area, visits by the nurse and the ACP before transferred to the OR, waking up in the PACU
Process
_____ informations is more specific explanation of what the physician will do before/during surgery
Procedural
Document teaching and patient understanding of teaching in the pre-op is the responsibility of the ____
Nurse
Why do we make pts NPO for surgery (2)
Post-op nausea/vomiting and aspiration
All patients should receive instructions on deep breathing, coughing, early ambulation post operatively unless they had what kind of two surgeries
Craniotomy or tonsillectomy
What is the major teaching that needs to be performed pre-op
Deep breathing/coughing or incentive spirometer (pts need to know before surgery otherwise may not want to post-op)
Deep breathing/coughing and or incentive spirometer promotes ____ ____ and prevents ____
Lung expansion; pneumonia
In pre-op we always want to inform patients/caregivers on ___ or ____ they will wake up with
Tubes or equipment
What are 3 things we need to inform the patient pre-hospital
Arrival time/place, food/fluid restrictions with when to begin, need for any home prep like an enema
Final preoperative teaching, assessment, verification of signed consent, labs, history and physical examination, baseline vitals, consultation records, nurses notes, surgical site marked by surgeon are all things done on the ____ ___ ___
Day of surgery
Why isn't a patient allowed to wear any cosmetics on the face for surgery
Need to observe skin color
Patients should not wear any cosmetics including ___
Deodorant
____ before surgery is important bc an empty bladder prevents involuntary elimination under anesthesia and reduces the risk of urinary retention during postoperative
Voiding
Hospitals often require that a patient wearing a hospital gown with no ____
Underclothes
______ are usually medications are given for their sedation and amnesic properties
Benzodiazepines
Valium and Ativan are examples of ____
Benzodiazepines
When giving benzodiazepines what do you monitor
RR
_____ Are sometimes given to reduce secretions in preop
Anticholinergics
Atropine is an example of a _____ med
Anticholinergics
What is the antidote for benzodiazepines (Ativan/Valium)
Ramazicon
What is the antidote to opioids
Narcan
Decreased respiratory rate, hypotension, constipation are all symptoms of ____ meds
Opioids
_____ medication are given for decreasing nausea and vomiting
Antiemetics
_____ medication Maybe given to decrease pain and intraoperative anesthetic requirements
Opioids
_____ are given 30-60 minutes IV before surgical incision and get 2 doses after surgery
Antibiotics
2 things that are recorded durning the transport to the OR
method of transportation and the person who transports the patient to the OR
What is the "handoff" communication
SBAR from transport team to nurse
What are two reasons the PACU is located adjacent to the OR
Limits transportation a patient after surgery and provides immediate access to anesthesia and OR staff
PACU is considered ______ area
Semi-restricted
The main goals of ____ care are toMaintain patient safety during recovery from anesthesia, identify actual and potential patient problems that may occur as a result of anesthesia/surgery, and to intervene appropriately
PACU
ABC (airway, breathing, circulation) are used in ____ monitoring
PACU
What is the number 1 nursing care focus in PACU
Vitals
During phase ____ post-op weakness of the chest muscles due to medication can occur, should be assessed
Phase 1
Phase ____ is considered initial recovery period in PACU
1
What do you use To manage her early signs of hypoxemia
Pulse ox
During phase _____ post-op, constant Vigilance is required and intense monitoring required
Phase 1
If a patient has a history of smoking the PACU nurse should do what first and then what
First listen to lung sounds then nicotine patch
Level of consciousness, orientation, sensory and motor status, size/equality/reactivity of pupils are all focused in the initial assessment of neuro in ____
Phase 1
Patient name/age, surgeon, surgical procedure, presence of tubes, drains, catheters, IV lines, type of anesthesia, use of any reversal agents, airway status, pain management interventions, and NPO are all stated in general information in the PACU ______
Hand-off report
Indication for surgery, medical history, preoperative or baseline vitals, level of consciousness, specific patient characteristics are all stated in the PACU hand off report of ____ ____
Patient history
Anesthetic agents, other drugs received preoperatively or during surgery, last dose of opioid administration, total fluid replacements including blood transfusions, urine output are all discussed during the PACU hand-off report explaining _____ ____
Intropertaive management
Unexpected anesthetic events or reactions, unexpected surgical events, most recent vital signs and monitoring trends, results of intraoperative lab test/x-rays are all discussed in the PACU handoff report explaining ____ ____
Intraoperative course
If a patient comes out of postop and has a low-grade fever what should we encourage the patient to do (1)
Cough/deep
Airway obstruction is commonly caused by blockage of the airway by the ____ ____ during post-op
Patients tongue
Patients who have had General anesthesia, are older than 55 of age, have a history of tobacco use, had pre-existing lung disease or sleep disorders, obese, go under airway/thoracic/abdominal surgery are at higher risk for ____
Hypoxemia
____ May be the result of bronchial obstruction caused by retain secretions, decreased respiratory excursion, or general anesthesia
Atelectasis
Airway obstruction caused by patient's tongue blocking your way what is the maneuver used to treat this
Jaw thrust maneuver
To prevent respiratory complications post surgery what is the proper patient positioning bc it keeps airway open and prevents aspiration if vomit
Lateral "recovery" position
Once the patient is conscious what is the position the patient can now lay in that maximizes chest expansion
Supine
Oxygen therapy, cough/deep breathing, change patient positions every 1 to 2 hours, early mobilization, adequate hydration, chest physical therapy, pain management or all interventions to prevent ____ ____
Respiratory complications
For respiratory complications we want to ______ Before ambulation or taking deep breath's/coughing
Pre-medicate
Changing the patients position every 1 to 2 hours post surgery to allow full ____ ___ and increase ____
Chest expansion; perfusion
Extreme hypotension = decreases ____
Perfusion
This orientated and decreased urine output can be a sign of ____ which could be caused by blood/fluid loss
Hypotension
Airway obstruction, hyperventilation, aspiration, atelectasis, pneumonia, hypoxemia, pulmonary embolism, bronchospasms are all complications post surgery of the _____
Respiratory
Dysrhythmias, hemorrhaging, hypertension, hypertension, superficial thrombophlebitis, Venus thromboembolism are all complications post surgery of the ____
Cardiovascular
Post surgery frequent vital signs are monitored every ___ - ____ minutes
3-5
During post surgery there is a continuous ____ monitor running to prevent/Recognize cardiovascular complications
EKG
Adequate fluid replacement, assess surgical site for bleeding, early ambulation, VTE prophylaxis, my tour for orthostatic blood pressure, slow changes in body position all help prevent post-op _____ complications
Cardiovascular
VTE prophylaxis includes what three things
Ambulation, stockings, anticoagulants
.If a pulse rate is less than 60 or over 120 in postop what should you do
Call surgeon
Blood loss and hemorrhaging can cause ___ ____ in post-op
Fluid deficit
Fluid overload, fluid deficit, electrolyte imbalance, acid-based disorders are all complications postoperatively concerning _____
Fluid and Electrolytes
_____ Urine output in the first 24 hours after surgery may be expected, regardless of fluid intake. This is caused by increased aldosterone and ETH the Grecian resulting from stress of surgery
Low
What are three lab values that need to be monitored for fluid and Electrolytes postoperatively
Potassium, BUN/creatinine, magnesium, h&h
If a patient has an increased BUN/creatinine what does that mean
Dehydrated
Low ____ causes Dysrhythmias and confusion
Potassium
What medication do we give to patients to prevent seizures postoperatively
Benzodiazepines
Pain, fever, delirium, hypothermia, post operative cognitive dysfunction are all complications related to ____ in post-op
Neuropsychological
Monitor her oxygen levels with pulse ox, oxygen therapy, pain management, reversal agents, assess for anxiety/depression, alcohol withdrawal protocol, fluid and electrolyte balance, adequate nutrition are all nursing interventions to prevent ____ complica
Neuro
What are three nursing interventions to prevent pain and discomfort postoperatively
Analgesics, epidural catheter, PCA pump
passive warming examples (2)
Warm blankets and socks
active warming measures (2)
Bear-hugger warmer and warm IV fluids
Shivering will decrease ___ levels
O2 levels
Temporary impairment of gastric in power motility after surgery, resulting from the handling or reconstruction of the intestines during surgery and limited dietary intake before and after surgery. Normal in abdominal surgery
Post operative ileus
Nausea/vomiting, distention and flatulence, post operative ileus, hiccups, delayed gastric emptying oral complications post operative of the ____ sustem
Gastrointestinal
example of antiemetics - for nausea (1)
Zofran
One example of prokinetics meds (increase GI motility)
Reglan
Nausea and vomiting post-op you can use ____ as ordered
Suction
Adequate hydration, assessing bowel function, early mobilization are all nursing interventions to prevent ____ Complications
GI
A patient is NPO until ____ ___ returns
Gag reflex
What are the two main complications post operatively of the urinary system
Retention and infection
Monitor urine output, adequate hydration, remove urinary catheter with no longer indicated, normal positioning for elimination, bladder scan/straight Kath per orders are all nursing interventions to prevent ____ complications post operatively
Urinary
Infection, hematoma, dehiscent's are all complications postoperatively involving the ____
Skin
What two types of people are more common to have dehiscence at the incision
Thin and obese
When assessing the wound postoperatively you want to note the drainage ___, ___, ___
Color, consistency, and amount
Assess affects of ___ ____ on wound/drain tube drainage
Position changes
Redness, warmth, discharge, fever are all signs of ___
Infection
If a patient is hyperglycemic they are at higher risk for ____
Infection
What is rapid PACU progression
Rapid progression through phase 1 to phase 2
___ ___ Is known as admitting patients directly to phase 2 postoperatively
Fast tracking
Aldrete score system - a score of __ -____ Indicates readiness to transfer or discharge to the next phase of recovery after surgery
9-10
_____ score system is used during the discontinuation of anesthesia to return of protective reflexes in motor function
Aldrete
____ score system is used to assess Transition from phase 1 to phase 2
Aldrete
What four criteria does the Aldred scoring system go off of
Level of consciousness, activity, respirations, circulation
Patent airway, patient awake, stability of blood pressure/heart rate, no respiratory depression, oxygen saturation greater than 90%, pain management, no excessive bleeding at surgical site, report given are all in the ____ ____ discharge
Phase 1
PACU phase 2 occurs in ... (2)
Inpatient setting or intensive care area
Phase ____ post-op Nursing care focuses on preparation for care in the home and extended observation
Phase 2
Stable blood pressure/heart rate, pain and comfort management, condition of surgical site, fluid/hydration status, voided, mobility status, emotional status, patient safety needs, significant others interactions are all used in the discharge criteria for
2
____ ____ Occurs in area for patient to receive continued observation and care (if patient isn't quit ready to leave phase2)
Extended observation
The nursing care for extended observation focuses on preparing the patient for ...
Self-care at home
____ Surgery involves patient receiving phase 2 and extensive observation post operative care
Ambulatory (same-day)
Must be mobile and alert, cannot drive, no IV opioids in the past 30 minutes, minimal nausea/vomiting, must be post anesthesia scoring system to determine readiness, void if appropriate for surgery, written discharge instructions given and understood is t
Ambulatory (same day)
For ambulatory surgery, same-day surgery, provide discharge education to both ____ and ____
Patient and caregiver
For ambulatory surgery, same day surgery, care of ___/____ is included in discharge
Incision/dressing
Discharge teaching for ____ surgery: Side effects of medication, activity allowed/prohibited, dietary restrictions, symptoms that should be reported, went to return for follow-up
Ambulatory surgery
Unrelieved pain, questions about medication, wound drainage and or bleeding, increased drainage from a drainage device, fever over 100 are al reasons to seek ...
Help after ambulatory surgery
Decreased respiratory function, altered vascular function, drug toxicity, mental status changes, pain control or all considerations of postoperative's ____ patients
Gerontologic
Patient becomes restless and agitated in the PACU as he begins to regain consciousness. The first action the nurse should take is to
Check the patient's oxygen saturation with the pulse oximetry
What is the number one sign of hypoxemia
Delirium
Well in the PICU, the patient's blood pressure drops from and then mission to pressure of 126/82 to 106/78 with a pulse change of 70 to 94. The nurse administers oxygen and then
Increases the rate of IV fluids (hypotension equals hypovolemia)
The nurse is preparing to discharge the patient from the ambulatory surgery center following an inguinal hernia repair. The nurse delays the release of the patient upon discovering that the patient ...
Has not voided since before surgery
Three outpatient facilities
Hospitals may have a surgical area, surgical centers, physician offices
_____ area is where people in street clothes can interact with those in surgical attire. These areas typically include the points of entry for patients like holding area, locker rooms, nurses stations or control desk. Family members allowed
Unrestricted
____ area includes support areas and corridors. Only authorized staff, no family. Surgical attire must be worn and cover head and facial hair.
Semi-restricted
____ area is operating rooms, clean core, scrub sinks, surgical attired required
Restricted
____ area reduces traffic in the Intra-op
Semi-restricted
Controlled environment, no windows, no extra chairs, designed to minimize Spread of infection, allow a smooth flow of patients/personal/equipment is known as the ____ ____
Surgical suite
Holding area is also known as ____
Pre-op
In the ____ ___ You will identify and assess the patient before transferring them to OR
holding area (pre-op)
Is the circulating nurse considered sterile
No
Does a patient before surgery have to sign that form for anesthesia
Yes
Preoperative medical history and physical assessment, patient safety and management in the OR, post operative management of the patient is the role of the ____
Surgeon
Pain control, airway management, vital signs, is that the head of the bed, and keeps the patient sedated is the role of the
Anesthesia care provider (ACP)
Does documentation of Assessment and watch a sterile technique of others in operating room is the role of
The circulating nurse
Stays next to sterile field and helps with procedure equipment is the role of the
Scrub nurse
What are two things that are done by the nurse before surgery
Perform a thorough physical assessment and make sure the chart is reviewed
When admitting the patient it is continued with a _____ or the patient and allowing time for ___
Reassessment ; questions
Before transferring the patient to the OR, prepare the room to ensure____,____,_____
Privacy, prevention of infection, and safety
What are two things that need to be confirmed before transferring a patient
identification and that the wheels have been locked on the stretcher
Scrubbing, Gowning and gloving- starts with ....
Hands then to elbows
Scrubbing surgical hand Anti-septic is required for all ____ ___
Sterile members
What do you need to do if you're scrubbing in and are using an alcohol based product
Wash hands first, dry, put on alcohol-based
While you check the OR to complete the final preparations, the ACP prepares the patient for
Administration of anesthesia
Provide correct muscular skeletal alignment, prevent undue pressure on nerves, skin on bony prominences come at your lobes, eyes, provide for Adequate thoracic excursion are all considered when
When positioning the patient on the operating table
With ____ Can cause delayed won't healing and altered drug metabolism
Hypothermia
What is the Purpose of skin preparation for surgery
To reduce the number of micro organisms available to migrate to the incisional wound
What are two people that bring the patient after surgery to the PACU and give report
ACP and perioperative team members
When preparing a surgical site what is the motion done on the site
Circular motions from the inside - out
What is the handoff procedure known as any interoperative process
SBAR
Who counts every piece of equipment used during surgery
Scrub nurse/scrub Tech
What kind of sedation is dues for procedures performed outside of the OR that does not require a anesthesiologist
Moderate to deep sedation
Anesthetic technique and agents are selected by the ____
Anesthesiologist
ASA Scale physical status is defined by patient's status immediately ...
Before surgery
ASA Scale (1-6)
1=healthy ; 6= brain dead
What type of anesthesia care is use for diagnostic or therapeutic procedures performed in or outside the OR
Monitoring anesthesia care
If you were doing moderate sedation what are two things you need
Only IV drip and advanced airway
There are two types of General Anesthesia
IV or gas
All routine general anesthetics begin with an ____ ____ agent, Whether it is a hipnotic or disassociation agent which will induce rapid sleep
IV induction
_____ used as a induction agent in general Anesthesia had fast onset's but low symptoms
TIVA
A ____ ____ using adjunctive Drugs to complement the induction, the most common approach used for general anesthesia aka rarely only using 1 agent
Balanced technique
Before using a neuromuscular blocker for surgery what do you have to do first
Intubate
Opioids, benzodiazepines, neuromuscular blockers, antiemetics are examples of ____ used with general Anesthesia
Adjuncts
Example of dissociation anesthesia
Ketamine
What is a side effect or ketamine and who is it normally given to
Kids; patient is angry- low stimulation to help this
_____ ____ Can be a topical, opthamalic, nebulized, or injectable
Local anesthetic
Two examples of regional anesthesia
Spinal and epidural block
_____ Is a regional anesthesia that is placed into the cerebrospinal fluid and has a faster Onest.
Spinal
spinal block side effects (1)
Headache
Anesthetic drug should be carefully titrated, assess for poor communication (heading/vision), Risk for tape, electrodes, and warming/cooling blanket is tearing or burning the skin, osteoporosis, hypothermic are all consideration of Anesthesia for ____
Elderly
What are three signs and symptoms of a regional anesthesia
Hypotension, bradycardia, nausea/vomiting
After having any kind of anesthesia what is a risk for all patients
Risk for falls
The initial clinical manifestations of anaphylaxis may be masked by ____
Anesthesia
Two most common anaphylactic reactions to surgery
Latex and anabiotic's
Hypertension, tachycardia, bronchospasms, and possibly pulmonary Adema or all symptoms of ____ ____
Anaphylactic reaction
____ ___ is a rare disorder characterized by hyperthermia with the rigidity of skeletal muscles that can result in death
Malignant hyperthermia
Does malignant hyperthermia run in family genes
Yes
What is the first sign of malignant hyperthermia
Tachycardia over 150
Increase temperature, tachycardia, tachypnea, shaking are all signs and symptoms of
Malignant hyperthermia
Malignant hyperthermia is caused by certain ____
Anesthesia
____ block doesn't enter the CSF
Epidural
During admission of the patient to the holding area or operating room before surgery, the perioperative nurse must
Ensure the patient identification with a formal identification process
During the admission of any regional anesthetic, it is most important that the nurse
Ensure that airway equipment, emergency drugs, and monitors are Immediately available
OU
both eyes
OS
left eye (lefts)
OD
right eye
Patient reads from Snellen chart at 20 feet distance. Or jaeger chart at 14 ft, Examiner note smallest print patient can read on each chart this is known as
Visual acuity test
Antihistamine side effects on eyes (1)
Causes dryness
Past health history, head/eye trauma, health problems like diabetes, surgery or procedures, patient's perception of the problem, nutritional patterns are all assessment findings you would want to ask for _____
Visual system (eyes)
Vitamin C/E and beta-carotene are good for what?
The eyes
Straining to defecate a.k.a. the Valsalva maneuver can raise the ____ ____
Intraocular pressure
Lack of sleep and may cause _____ ____
Ocular irritation
A patient with severe vision loss may develop such a poor self image that the ability to be ____ is lost
Sexual
Observe the corneal light reflex to evaluate for ____ and ____ of Extraocular muscles
Weakness and imbalance
How do you test the extra ocular muscles
Pulled a finger/object within 10 to 12 inches in front of the patient's nose and or shining penlight directly into the cornea
Assessment of visual system always is based on what is appropriate for ____ ____
Specific patient
The purpose of a _____ ___ test determines distance and near visual acuity
Visual acuity
Patient faces examiner, covers one eye, fixate on examiners fees, and Council number of fingers that the examiner brings into patient's field of vision. It's called ____ ____ ____ test
Confrontation visual field test
Determines if patient has a full field of vision is the purpose of ____ ____ ____ test
Confrontation visual field test
Examiner shines light into patients people and observes people every response. Each people is examined independently, examiner also checks for consensual and accommodation this test is called ____ ____
Pupil function test
Determines a patient has normal people Larry response is the purpose of a ____ ____ year
Pupil function test
Cover and a probe is gently touch several times to anesthetized Corneal service. Examine her records several readings to obtain a mean inter-ocular pressure this test is called ____ ____ ____/ ____
Intraocular pressure testing/ tonometry
In this test a patient identifies numbers or pass form by pattern of dots in a series of color plates, this test is known as ____ ____ testing
Color vision
____ is used for judging distance/binocular vision
stereopsis
_____ vision allows a patient to see objects in 3D
stereoscopic
_____ is the measurement of intraocular pressure
tonometry
for the eye a normal cornea is ____ and the iris is ____
clear; flat
____ exam is looking for retina and optic nerve detachment
fundoscopic
during the pupil function test, when you bring the object close to the pts eyes the pupils should ____
constrict
anisocoria is unequal ___ ____
unequal pupil size
____ measures the refractive error. patient sits and looks at a snellen chart and chooses the line that is the sharpest.
refractometry
____ ___ injected IV peripheral vein followed by several photographs of retina
fluorescein angiography
___ ____ Test detects early macular degeneration
amsler grid test
____ patients are at risk for falls due to depth perception problems
stereopsis
for ____ staining it may cause it to appear yellow
corneal
____ ____ test is used by looking at a card with one eye at a time
amsler grid test
___ ____ will dilate the pupils for 12 hours
fluorescein angiograhy
fluorescein angiography, make sure the pt has no ____ allergies
iodine
fluroescein angiography the skin can turn which color
yellow
two ways to correct ____ ___ is glasses/contacts and surgical correction like LASIK
refraction error (vision loss)
vision limited to close objects is called ___ vision
low vision
legal blindness is considered ____/____
20/200
____ ____ causes blurred vision and headaches
refraction errors
____ ____ ____ is the inability to read newsprint even with glasses
severe visual impairment
how do you cleanse the eye (4)
baby shampoo, gentle scrub, thorough rinse, inner to outer
routine exam with eye doctor to help catch/treat ____ early
glaucoma
_____ can cause retinopathy
diabetes
saftey considerations for the eyes is to always wear _____
eye protection
2 sun protection measures for the eyes
sunglasses and hats
Sighted guide technique
guiding a visual impairment pt by the arm. "here is a few steps
extent of vision loss ("how long?"), pt perception of vision loss effects ("how bad?") are things to ask a pt on vision loss during the ____
assessment
braille/audio books, magnifiers, computer based programs, and large text are all _____ for vision loss patients
implementation
___ is nearsightedness which is an inability to accomodate for objects at a distance
myopia
___ is farsightedness is an inability to accomodate to near objects
hyperopia
____ is the loss of accomodation associated with age. ( around age 40)
presbyopia
____ is caused by an irregular corneal curvature causing incoming light rays to be bent unequally.
astigmatism
if there is an object in the eye what should you do
stabalize it, do not remove it
_____ is called blood in the eye
hyphema
____ is bruising of the eye- black eye is common with this
contusion
____ is inflammation of the eyelid usually caused by bacteria causing itching and burning
blepharitis
infection of the sabeous gland on lid is called ____
sty
what is the tx for a sty
warm compresses
___ is inflammation of the cornea that can be bacterial, fungal, etc
keratitis
____ is known as eye popping out of socket
enucleation
pain, photophobia, redness/swelling, ecchymosis, discharge are all things that should be ____
assessed
you can flush the eye with normal saline only if ....
nothing is penetrating it
when a eye has trauma do not apply ____
pressure
if a pt has eye trauma, teach the pt to not ___ ___
blow nose
how do we want to postion a pt with eye trauma
elevate the head
Morgan lens is
Equipment used for eye irrigation
what 3 types of medication are used for eye infections
antibiotics, lubricants, analgesics
for eye infections what do we want to monitor for
corneal ulceration
____ is opacity within the lens, which may occur in 1 or both eyes
cataracts
blurred vision and light sensitivity are s/s of ___
cataracts
cataracts post-op surgery what do we not want the pt to do
sneeze/cough - increases pressure
age, trauma, congenital factors (maternal rubella), radiation/UV light, ocular inflammation are all risk factors for _____
cataracts
Long term corticosteroid use can cause what to happen to the eyes
cataracts
decreased vision, abnormal color perception, glaring of vision is s/s of ___
cataracts
___ ___ of the eye is an emergency
retinal detachment
photopsia ( bright flashes of light), floaters, cobweb/hairnet vision/curtain sensation, painless, vision loss are all s/s of
retinal detachment
surgical repair, scleral buckling, virectomy are all tx for
retinal detachment
for a pt that has just has surgical repair for retinal detachment what is the nursing consideration for the pt care (2)
bed rest and head position
post-op care for ___ is to wear sunglasses, avoid radiation, ensure adequate antioxidant vitamins, ensuring good nutrtion
cataracts
after ____ surgery no bed rest is necessary
cataracts
if a pt has a patch from post-op cataract surgery we need to inform them that they will no longer have ___ ___
depth perception
surgery is the only true cure for ____
cataracts
nonsurgical therapy for cataracts involves ___ ____
visual aids
cataract post-op eye drops are ____ anti-inflammatory
nonsterodial anti-inflammatory
drainage, redness, long term pain after any eye surgery, the pt should....
notify surgeon
cataract surgery is usually an ____ surgery unless there is complications
outpatient
remove rugs and preparing frozen meals in the house for a pt after _____ surgery
cataracts
expected outcomes of ___ surgery is to have improved vision, ability to care for self, minimal to no pain
cataracts
If a patient is Receiving two different kinds of eyedrops how far do you space them apart
Five minutes
____ is a group of disorders characterized by increased intraocular pressure And consequences of elevated pressure, optic nerve atrophy, peripheral vision field loss
Glaucoma
_____ is an eye disease that creates a tunnel vision
Glaucoma
____ Is the second leading cause of permanent blindness in the United States, especially in African Americans
Glaucoma
____ pressure in the eyes is 10-21
Normal
_____ glaucoma pressure in the eyes is 22-32
Open-angle
Acute _______ glaucoma pressure in the eyes is 50+
Angle-closure
slit lamp test (under microscope), IOP pressure monitor (pen on eye), confrontation test, ophthalmoscopy are all used to diagnose ____
Glaucoma
When looking for the progression of Glaucoma, using ophthalmoscopy the ____ ____ will look wider, deeper, and paler
Optic disc
What is the most common type of Glaucoma
Open angle
_____ Glaucoma is caused by The drainage channel is becoming clogged which damages the optic nerve. No symptoms and develop slowly. Unnoticed until proof real vision is severely compromised
Open-angle
_____ glaucoma is usually caused by the lens bulging forward. Caused by old age, pupil dilation, possibly drug induced. Has a very sudden onset
Angle-closure
Expected outcomes of glaucoma treatment would be no further ______ ____
Vision loss
B-blockers, A-andrenergic blockers, miotics/cholinergic, CAI diuretics are all tx for ____
Open-angle Glaucoma
____ ____ ____ is a noninvasive laser that stimulate scarring and contraction of the tubular mesh work which helps drain the eye used to treat Glaucoma
Argon laser trabeculoplasty
___ Is a medication used to treat glaucoma that constricts the pupils and decreases visual acuity in dim lighting
Miotics
Two types Of macular degeneration and which one is more severe
Wet and dry; wet is more severe
Older (60+), White, Family history, smoking, hypertension are all risk factors for ____ ____
Macular degeneration
Vitamin c, e, zinc help prevent ___ ____ in eyes
Macular degeneration
There is limited tx for ____ _____
Macular degeneration
Biological Injected directly into the eyes, every 4 to 6 week schedule is the treatment for ___ ____
Macular degeneration
After tx of ____ ____ where you inject biologics into the eye we need to watch for Irritation, pain, photosensitivity, blurred vision
Macular degeneration
Another tx for ____ ___ is photodynamic therapy Which the eyes must be covered for at least five days after treatment
Macular degeneration
____ is central vision loss
Scotomas
Amsler Grid Test helps test for ____ ____
Macular degeneration
___ Is it a medication that dilates the people
Mydriatic
Aspirin, NSAID, chemo, Vancomyocin are all ____ meds
Ototoxic
Vertigo, dizziness, nystagmus, Past history of child illness, problems of organs adjacent to the ear, any surgical treatment of the ear are all things we want to know during the ____ for the war
Assessment
What are three examples of behavioral adjustment indicating hearing difficulties
Turning head to hear, reading lips, asking to repeat
When assessing the external ear we want to make sure that it is ____ not _____
Symmetrical and not deformed
When looking at the auditory canal of an adult how do we pull the ear. Child?
Adults pull back and up. For children pull down
_____ is an effective screening tool used Tones to establish hearing threshold
Audiometry
Weber test, rhinne test use tuning forks to test what
Hearing
What are two types of hearing loss?
conductive and sensorineural
____ hearing loss is Sound transmission to the inner ear impaired, patient often speaks softly, suggest hearing aids, reversible
Conductive
____ hearing loss is results in the inability to hear sounds in inability to understand,There is multiple causes, hearing aids make sound louder but not clear, damage to the nerve
Sensorineural
Can you have both conductive and sensorineural hearing loss
Yes
Central and functioning hearing loss is due to ____ problems
CNS
____ Is hearing loss associated with aging
Presbycusis
_____ Is perception of noise without any actual source of sound. Ringing of the ears. First symptom of hearing loss
Tinnitus
___ is the hardening of the middle ear, tympanum takes on a reddish blush, poor air conduction. Treated with medications that slow bone reabsorption/hearing aids
Otosclerosis
Cerium impaction, The nurse will assist with ___ and ____ from ear
Softening and irrigating
acoustic neuroma is a tumor on the ____ ___
Acoustic nerve
What is the most preventable cause of hearing loss
Environmental noise control
Hearing loss caused by noises __ ____
Not reversible
______ should be scheduled regularly for child and adults to help prevent hearing loss
Immunizations
When do you remove hearing aids and how often do you change the
Remove in shower and at night, change battery once a week
Speech reading, sign language, implantable hearing devices, cochlear implant's are all assisted devices for
Hearing loss
____ ___ Are use for severe to profound sensorineural hearing loss in one or both ears
Cochlear implant's
____ ____ Are ideal for people who have become deaf after acquiring speech and language
Cochlear implants
If a patient has cochlear implant's what is one type of therapy they are going to need
Speech
Tympanic Rupture is a ____ in the ____
tear in the eardrum
Stool softener, H202 solution, give meds before irrigation attempt in only use these if the temp panic membrane is not ruptured are tx for ____ ____ ____ of the ear
Foreign body removal
When irrigating the year what are two considerations for this
Warm water and low pressure
____ is inflammation of the mastoid bone (behind the ear)
Mastoiditis
____ _____ is known as swimmers ear, and it's the inflammation of the external ear
Otitis externa
otitis media is inflammation of the ____ ____
inflammation of the middle ear
labyrinthitis is inflammation of the ____ ____ known as ear infection
Inner ear
Dizzy, pain , ringing, popping are all symptoms of ___ ____
Ear infections
Anabiotic's, analgesics, anti-histamine's, anti-vertigo, warm/cold compress are all nursing care for ____ ____
Ear infections
If ear affections are Recurrent there may be a need for surgery known as ___
Tubes
____ disease is episodic vertigo known as "drop attacks
M�ni�re's disease
Restrictions of sodium/caffeine/nicotine/alcohol/MSG, medication/surgery if it's severe are all treatment options for ____ ____ of the ear
M�ni�re's disease
BPPV (benign paroxysmal positional vertigo) is caused by ____ ____ in semicircular canal
Debris floating
______ is caused by debris floating in Canal, which will cause vertigo with specific head movements, no hearing loss
BPPV (benign paroxysmal positional vertigo)
Epley maneuver is where you turn your head to move debris around which is tx for
BPPV (benign paroxysmal positional vertigo)