34.

client confused assessment by nurse

35

A client come to EMT and is

unconsciuos after a head trauma, what care nurse will do?

abc question

pt airway first, stabilize cervical spine, administer O2 via non-rebreather mask, establish IV access 2 large bore catheters to infuse NS or lactated ringer’s solution, control bleeding with sterile pressure dressing, assess for rhinorrhea, otorrhea, scalp wounds, remove patient’s clothing. 

On going monitoring= maintain patient warmth with warm blankets and warm IV fluids, overhead warning lights, warm humidified O2, monitor vital sighns, LOC, O2 sats, cardiac rhythm, GCS scores, pupil size and reactivity, anticipate need for intubation if gag reflex impaired or absent, assume neck injury with head injury, administer fluids cautiously to prevent fluid overload and increasing ICP. 

send client to CAT scan if they said have bleeding problem

cl just had a seizure, N document unusual sounds, small prior to sizure=Aura

36

Lumbar puncture

ü                  Lumbar punture is the most common method of obtaining CSF for analysis. 

not do:infection at the site of puncture,trauma, or increase ICP

Nurse : prepare LP tray for Ph 

-  urinate before procedure, lie in lateral recumbent position with back as close to edge as possible, help patient draw knee to chest and flex head to chest. 

- The physician inserts needle below 3^rd lumbar. 

37.

signs of Increase ICP

ü                  Confusion, restlessness, disorientation are early signs.  Later signs changes in LOC, vital signs, ocular signs, decrease in motor function headache and vomiting without nausea.  Page 1471

hard to arouse, not act normal, unresponsive, cannot awake

38

Decorticate

Decerebrate

     Decorticate posturing= flexion of arms, wrists, fingers with adduction in upper extremities.  Extension, internal rotation and plantar flexion in lower extremities. ( posturing toward core of body)

 posture in

Decerebrate posturing- all four extremities in rigid extension with hyperpronation of forearms and plantar flexion of feet. 

 posture out

39.

Stroke Risk Factor

HTN

ü                  Major risk factor is hypertension.   Non modifiable risk factors- age, gender, race, family history, and heredity.  Risk increased with age.  2/3 of strokes occur in people 65 or older.  African Americans have a higher risk. 

Modifiable risk factors- hypertension, heart disease, smoking, excessive alcohol consumption, obesity, sleep apnea, metabolic syndrome, lack of exercise, poor diet and drug abuse.  

40.

Priority in stroke patient

ü                  Maintain Airway remember ABCs page

  FAST------  

F face uneven smile, facial numb/tingling ,vision disturbance

 A- arm and leg- weak, numb, difficult to walk

 S- speech slurred or inappropriate words, mute

 T- time- critical

41.

medication for stroke, TIA, contraindications for medications

ASA DO NOT GIVE IF BLEED SEND FIRST TO CT SCAN            ü                  Ticlid, plavixü                  persantine, ü                  aggrenoxü                 

do not give if bleeding anticoagulant drugs such as coumadin(which are for long term treatment). 

42.

PLAVIX

            Drug that prevents platelet aggregration its given to treat/prevent transient ischemic attacks/ strokes/ TIA.

   All health care providers and dentists must be informed that drug is being taken, especially before scheduling surgery or major dental procedure. Is for life             

      Drug may need to be discontinued 10-14 days prior to surgery if antiplatelet effect is not desired.

ischemia ü            give plavix to stroke patient helps to keep platelet in the blood form sticking together to form clots  

43.

carotid endartectomy

44.

CLIENT

RIGHT SIDE VS LEFT  SIDE OF STROKE

if left side stroke right side afected

right side is HIGH RISK FOR SAFETY FALLS

        right                                                         Left                              

UNAWARE DEFICIT                                       aphasia 

Disoriented time and place                                  alexia agraphia     Impulsivity                                                         slow and cautions Poor judgment                                                    speech and cry

More risk falls                                                    depression 

 Safety problem                                                   Anxiety  

Left sided (of the brain)  affects right side of body  

Right sided affect the left side of the bodyü                 

 Wernickes language and speechü                  Broca- movement

45.

assisting a client w/ mobility and transfering technique

46.

TIA medications

ASA is THE BEST

PLAVIX

47.

HEMORRHAGIC STROKE AND PRIORITIES IN ASSESMENT

very abrupt, very sudden, HA, sudden and vomiting client

skull fracture, rule out bleeding and send to ct scan

CL TAKE COUMADIN BLEED=> ASK ABOUT BLEEDING =>TELL TO PH

N&V HA SEND TO DO CT SCAN

Assess if they take any meds that can worsen bleeding (coumadin, heparin, etc.) 

48.

MEDICATION FOR HEADACHE

TYLENOL IS THE BEST , ASA, ACETHAMINOPHEN(30-60 MIN OF ATTACK)

B BLOCKER PROPHYLACTIC: INDERAL, VERAPAMIN, ZONAX, IMITREX (STRANGER)

TX before HA +VOMITING BECOME BAD 

FIORNAL(CAFEINE+TYLENOL+BUTABETOL). 3 MEDS COMBINATION give 30-60 min after attack

or b/t attacks

methyseride given , prophylactic –beta blockers ( inderal or verapamil) imitrex, zomig, narcotics, antiemetic  (decadron),

Beta-adrenergic blockers: propanalol (inderal), Antidepressants:  amitriptyline (elavil), imipramine (tofranil),

Antiseizure: Valproate (Depekene), topiramate (topamax),

Calcuim channel blockers: verapamil (isoptin).

Cluster Headaches:  Alpha-adrenergic blockers: ergotamine tartrate, Vasoconstrictors, Oxygen, Serotonin antagonists: methysergide (Sansert), Corticosteroids (prednisone), and Calcuim channel blockers: verapamil (isoptin), lithium. 

49.

SEIZURE CARE for a client

 PROTECT FROM INJURY , DOCUMENT TIME, LOCATION, HOW LONG

1.       AIRWAY      2.       NOT PUT NOTHING IN MOUTH

3.       ANTICONVULSANTS      4.       O2 MANAGEMENT

5.       ATIVAN, VALIUM

  Interventions:  Ensure patient airway, assist venilations if necessary, suction as needed, stay with patient unil seizure has passed protect patient from injury, do Not restrain, establish IV access, remove or loosen tight clothing, monitor VS, LOC, O2 sat, Glascow Coma Scale, pupil size, and reactivity, reassure and orient patient after seizure.

50.

seizure clasification:

·   Generalized seizures (nonfocal origin):  tonic-clonic, absence, myoclonic, tonic, atonic, and clonic.

·   Partial seizures (focal Origin):

 Simple partial ( no impairment of consciousness)  with: motor signs, sensory symptoms, autonomic symptoms, and psychic symptoms.

      Complex partial seizures (impairment of consciousness):  simple partial onset followed by impaired consciousness, impairment of consciousness at onset, and with automatisms.

***partial seizures evolving to secondary generalized seizures.

****Drug to administer while patient is seizing: is Ativan or Valium

51.

tonic clonic seizure interventions

put pt in side way position

suport +protect head

loose constricted cloths

oral airway should not inserted during seizure

suction+O2 tube put after if needed

after seizure allow pt to sleep as much as he wants.

LOC if needed when head injury must do

52.

Generalized seizure (GS)

has a bilateral synchronous epileptic discharge afect affect entire brain at onset of seizure, no aura  preventing or warning.

last second to minutes

53.

PARTIAL SEIZURE(PS)

BEGIN IN ONE SIDE OF THE BRAIN AND WITH A LOCAL FOCUS AND SPREAD TO ENTIRE BRAIN GENERALIZING

DO NOT LOOSE COUNSCIOUSNESS

CAN HAVE TONIC CLONIC EPISODS VERY BRIEF UNDETECTED

TODD'S PARALYSIS - after seizure u have, focal weakness that resolve after awake. 

54.

GS

 CAUSE OF TONIC CLONIC SEIZURE

SUDDEN, TRIGERS, ABNORMAL BURST OF ELECTRICAL DISCHARGE ACTIVITY

called GRAN MALL

STIFNESS AND JERKING

TONIC PHASE: STIFFNESS 10-20 SEC

CLONIC PHASE: JERKING 20-30 SEC of extremities

SS:cyanosis, excesive salivation, incontinence, tongue+cheek bitting

55.

GS

Typical Absence

PETIT MALL

CHILDREN SPECIFIC, SHUT DOWN, can happen 100x/d

last just few seconds startling spell

56.

GS

ATYPICAL ABSENCE SEIZURE

57.

GS

MYOCLONIC GENERALIZED SEIZURE

CONSTANT JERKING VERY BAD, CAN HURL THE PERSON ON THE FLOOR, CLUSTER, BRIEF

57.

SG

TONIC SEIZURE

58.

 GS

CLONIC

59.

GS

ATONIC (DROP ATTACK)

HAVE TONIC EPISODES, OR PAROXYSMAL LOSS OF TONE

BEGIN W/PERSON FALL TO GROUND, BUT REGAIN COUNSCIOUSNESS WHEN HIT GROUND

HIGH RISK INJURY (TEST)

60.

PS

SIMPLE PARTIAL SEIZURE

SIMPLE MOTOR, SENZORY PHENOMENA

 NOT LAST >1 MIN

NOT LOSS COUNSCIOUSNESS

FOCAL MOTOR FOCAL SENZORY, JACKSONIAN

FIBRAL AWAKE

61.

COMPLEX PARTIAL SEIZURE

TEMPORAL SEIZURE

last>1min folowed by short time of confusion, (not lost of counsciousness)

focal motor, focal senzory

LIP SMAKIN, AUTOMATISM(repetitive mvt not apropiate) called phychomotor seizure

Ex: cl continuu an actv. initiated bf seizure: continuu count change, picking items from grocery, but after seizure they not remember

- pickling  clothing, fumbling w/object (real/ imaginary), walking away

1.

hemolyses and jaundice rt to hemolytic anemia

PNC

MEDS: pnc, indomethacin, phenilbuthazone, phenacetin, quinine, aldomet.autoimmune disorder (reaction), meds cause secondary autoimmune reaction when other dis. such as arthritis, , meds PNC

PNC high risk

Integumentary Changes* include pallor, jaundice, and pruritus. Pallor results from reduced amounts of hemoglobin and reduced blood flow to the skin. Jaundice occurs when hemolytic of RBCs results in an increased concentration of serum bilirubin. Pruritus occurs because of increased serum and skin bile salt concentrations. In addition to the skin, the sclera of the eyes and mucous membranes should be evaluated for jaundice because they reflect the integument changes more accurately especially in a dark skinned individual

HEMOLYTIC Anemia caused by increased erythrocytes destruction,(Anemias resulting from destruction of RBCs)Hemolytic anemia: are hereditaryASA, SULFONAMIDES, THIAZIDE,DIURETICSTx.: HYDRATION + TRANSFUSION

No symptoms, until exposed to this agents, when exposed, RBC break ( Hemolysis) anemia, jaundice develop

2.

client at risk for hematologic disruptions

3.

S/S OF ALL ANEMIAS (INCREASE WORKLOAD)

CHF BCZ INCREASE OVERLOAD:SOB, DYSPNEA, ORTHOPNEA, PALPITATION, INCREASE HR, P, SYSTOLIC MURMUR, BRUITS, PERYPHERAL EDEMA, PALLOR

O2 => increas HR, stroke volume=>VISCOSITY OF BL=> SYSTOLIC MURMUR + BRIUTS.

WHEN OTHER DIS IS PRESENT  ANGINA PECTORIS,  MI,and if O2 NEEDS NOT MET=> HEART FAILURE, Cardiopulmonary AND SYSTEMIC CONGETION, ASCITE, PERYPHERAL EDEMA develop bcz HEART IS OVERLOAD.=>HYPERTENSION  CAUSING HEADACHE  TACHYCARDIA

S&S:HYPOXIAGI: sore tongue, anorexia, N&V, abdominal painNeuro: ATAXIA, weakness, confusion, dementia, parenthesia hands feet.Erythrosytosis: abnormal increase in RBC or POLYCYTEMIA

Secondary- due to chronic hypoxia

COPD cl body make more cell=> need more O2=> increase RBC

Clinical manifestation: HYPERVOLEMIA+HYPERVISCOSITY a lot volume and thick =>    HYPERTENSION: HA, DIZZY, TINNUTUS, VISUAL-          Impaired blood flow, circulatory stasis( clots stay there), thrombosis, => Tissue hypoxia=>  angina, chf, intermittent claudication, thrombophlebitis, embolization-          pruritus, -          Hemorrhagic : ecchymoses, petechiae, epistaxis, GI bleeding.-          Enlarged liver, spleen

4.

S/S OF PT WITH CHRONIC ANEMIA(CHRONIC HYPOXIA)

CLUBBING OF THE FINGER, CYANOSIS

most susceptible iron def very young , poor diets, women in reproductive years  

erythropoietin,  polycythemia ,  hypertension , Hypervolemia  tachycardia ,  tachypnea , vertigo ,  orthopnea,  bone pain ,  pallor ,  jaundice , purities , 

glottis, cheilitis (inflammation of lips)  ha,

paraesthesia, burning sensation of tongue

5/6

2 questions on hypo/hyper/ normochromic

hypo/hyper/normocytic

MICROCYTIC  HYPOCHROMIC:

IRON   SMALL CELL PALE JAUNDICE

MACROCYTIC,  NORMOCHROMIC:

B12, FOLIC ACID  LARGE CELL NORMAL COLOR

NORMOCYTIC  NORMOCHROMIC:

HEMOLYTIC, APLASTIC  NL COLOR, NL SIZE JUST INCREASE RBC

7.

iron deficiency anemia

physical assesment

ü                  pallor of skin and nail beds:  paleness, decrease or absence of skin coloration, periodic episodic redness of skin( usually around face, neck)ü                 

jaundice: yellow appearance on skin and mucous membrane, and eyes have jaundice in the sclera( you need to asses that specially with black people)ü                 

pruritus : this is always a later sign of any anemia, if u will have a question on this pruritus is later sign, pallor, dyspnea, jaundice is early sign ok?ü                 glossitis (inflammation of the tongue)-second most common, ü                  cheilitis (inflammation of the lips),ü                  headache, praesthesias, ü                  burning sensation of the tongue., very important to but is later sign with pruritusü                  smooth tongue and shiny, mucosa is thin and red from decrease papillae

assess if duodenum removal or by pass, pg woman, premature inf born

8/9

aplastic anemia (definition and nursing diagnosis)

definition: is a disease in which the patient has peripheral blood pancytopenia ( decrease of all blood cell types-RBCs, WBCs, and platelets) and hypocellular bone marrow.   

   Nursing diagnosis: High risk for infection because of neutropenia and high risk for bleeding because of thrombocytopenia……………..oral bleeding  Impaired oral mucosa rt low platelets, aeb bleeding oral , bulla

10.

MCV DEFINITON

MCV= SIZE OF THE CELL : -         

high MCV => MICROCYTIC ANEMIS-         

nl MCV=> NORMOCYTIC ANEMIA-         

low mcv=> MACROCYTIC ANEMIA

11.

PANCYTOPENIA dX TEST TO DIAGNOSIS

BONE MARROW

CBC: RBC, WBC, PLATELETS, Hb, Hct (most imp. cbc )Peripheral smear: EXAMNE SHAPE / SIZE

BM aspiration procedure: needle used w stylet is removed, a syringe is attached, contain aspirated, cl feel pressure and sharp pain. Inform consent , asepsis technique

12.

POLYCYTEMIA VERA

DEFINITION

-          definition: Polycythemia vera is an abnormal increase in blood cells (primarily red blood cells) due to excess production of the cells by the bone marrow.

ü                  Low red blood cells count (anemia) ü                 

 Low white blood cell count ü                 

 Low reticulocyte count (reticulocytes are immature red blood cell) ü                  Low platelet count  

13.

POLYCYTEMIA VERA

Clinical manifestation: HYPERVOLEMIA+HYPERVISCOSITY a lot volumer and thick => HTN( hypertension).-          HYPERTENSION: HA, DIZZY, TINNUTUS, VISUAL-          Impaired blood flow, circulatory stasis( clots stay there), thrombosis, => Tissue hypoxia=>  angina, chf, intermittent claudication, thrombophlebitis, embolization-          GENERALIZED PRURITUS. -          Hemorrhagic : ecchymoses, petechiae, epistaxis, GI bleeding.-          Enlarged liver, spleen

S&S:DARK, FLUSHED APPEARANCE OF FACE, MUCOUSE MEMBRANE, PURPLISH, CYANOTIC( bl not oxygenated.) ITCHING R/T VASODILATION, BL VISCOSITY INCREASE.VASCULAR STASIS DUE TO “SLOW” BLOOD, LEADS TO THROMBUS  FORMATION, OCLUDE BL VESSELS, INFARCTION AND NECROSIS

HEART: CVA, CHF, HYPERTENSION, HYPERKALEMIA, ENLARGED SPLEEN, BLEEDING TENDENCY, SWOLLEN PAINFULL JOINTS.

15.

POLYCYTHEMIA VERA

GENERAL CRITICAL VALUES

1. elevated hemoglobin and RBC count with microcytosis, 2. low to normal EPO level (secondary polycythemia will have a high level), 3. elevated WBC count with basophilia, 4. elevated platelets (thrombocytosis) and platelet dysfunction, 5. elevated leukocyte alkaline phosphatase, uric acid, and cobalamin levels 6. elevated histamine levels.  Bone marrow examination in polycythemia vera shows hypercellularity of RBCs, WBCs, and platelets.  Splenomegaly is found in 90% of patients with primary polycythemia but does not accompany secondary polycythemia.

general critical lab values :·                     

  increase  of Hgb concentration >(18) normal 12-16·                    

   Increase of RBC >6 MILIONS normal 4-6·                    

   Increase of Hct > 55%--normal 45-55%

16.

POLYCYTHEMIA VERA

MI

16.A

POLYCYTHEMIA

TEACHING - TREATMENT

     Aimed at prevention of clot formation, monitor CBC, increase hydration ( 3L/day)

  Phlebotomy Remove blood if too much o        Remove 500ml at time o       1 ½ l PRBC removed from body done every 2-3 months

ALOPURINOL for GOUT BCZ HYPERURICEMIA

Maintain adequate nutrition ·                     Stop smoking ·                     Control chronic pulmonary disease ·                     Avoid high altitudes ·                     Need to ambulate /leg exercises when possible ·                     Risk for clot

16. B

POLYCYTHEMIA

NURSING MANAGEMENT TEACHING

-          O2 -          Assist w phlebotomy-          I&O-         

 Mon complication WACH FOR CLOTSSSSSSSSSSSSSSS-         

Prevent immobilization, TURN PT Q2H-       

   Education: adequate fluids, avoid tight cloths, no ASA( BLEEDING ), anticoagulant education , gloves  in cold winter 

NO HIGH ALTITUDES

17.

1 GROUP AT RISK FOR VISUAL PROBLEMS

DIABETIS MELITUS

RETINOPATHY, HTN, OLDER, MACROOCULAR DEGENERATION

18.

 ASSESMENT OF EYES- PHISICAL FINDINGS

In a small percentage of the population the pupils are unequal in size (anisocoria).  Ask patient if that is normal. 

hyperopia: fairsightness( see better far away, do not see close). 

Myopia: nearsightedness: ( see beter close , not see far)sclera = white cornea= transparent

red reflex if move one eye need to do same with other, if one contract pupils same with other

N ask: Is that normal for you to have one eye bigger then the other? 

vision begins with the eye and is fully perceived in the brain   changes in eye and vision can provide impt data regarding the clients current health status look at sclera--  white  cornea transplant                                    

 History(subjective data) demographic
data, personal and family history, diet history (vitamin A deficiency),
social economic status, current health history
PHYSICAL ASSESSMENT: inspection, head tilting, squinting (double vision
may cock/tilt head), symmetry (equal distance between eyes), eye placement
in orbits (exophthalmos eyes protrude, enophthalmos eyes are sucken)
SCLERA & CORNEAL ASSESSMENT:  examine for clolor (usually white yellow may
mean jaundice), corneal should be smooth, transparent, shiny and
bright(cloudy areas or specs may be a result of injury), blink reflex (
take a cotton ball and rub corner of the lashes and see if they blink)
PUPILLARY ASSESSMENT: pupils are round and equal in size (between 3-5mm)pinpoint dilated are associated with drugs or neuro disruptions, size
varies with light exposure, pupils are smaller in older adults, OD=Right
eye OS= Left eye OU= both eyes, evaluated for speed of reaction(brisk
rapid response, sluggish more than one second to constrict,
nonreactive/fixed failure to react to light don?t document this on live
patient)
Chart on pg 404 shows normal physical assessment findings
*<visual acuity 20/20OU>: no diplopia
*external eye structures symmetrical and without lesions or deformities
* lacrimal apparatus nontender and without drainage
* conjunctiva clear; sclera white          PERRLA          LEANS  clear
* disc margins sharp      retinal vessels normal, with no hemorrhages or spots

19.

INSTALATION OF THE EYE DROPS

instill medicine in the lower conjunctival sac and not to the eye itselfü               

   lower eyelidü                 

inner cantus of eyeü                 

don’t touch with finger when inserting into the eye—keep sterileü                  don’t share medication

20.

FURTHER TEACHING RT TO DROP INSTALATION

21.

CYCLOPEGIC DRUG THERAPY

PROTECT EYES

DILATE PUPILS,

22.

MEDICATION DECREASE IOP

23.

VISUAL ACUITY

SNELLEN CHART DEFINITION

24.

ANGLE CLOSURE GLAUCOMA

ü                  Mannitol and diamox to decrease IOP- diureticsü                           ocular emergency- requires immediate intervention ü                           miotics and oral or IV hyperosmotic agent to decrease IOP ü                           laser peripheral iridotomy or surgical ü                       

    procedures allow aqueous humor to flow thru newly created openings in iris and into normal outflow channels ü                          

miotics- warn pt about decrease visual acuity esp in dim light ü                          closed angle increase IOP ü                  Secondary or closed angle– worse bc there is no outlet in the IOP, so it increase the IOP greatlyü                   sudden onset;

tx as emergency; displacement of iris against cornea obstructing outflow of aqueous humor ü                

  Angle glaucoma causes Blindness and hemorrhageü                

 LIFE LONG THERAPHY TEACH, surgery may be neededü                  Less common,sudden onset ,

YOU cannot  RESTORE THE LOST VISION BUT YOU CAN PREVENT FUTURE LOSS EPISODS OF VISION.ü                  Permanent DAMAGE  ü                  GLYCERYN LIQUID

25.

EYE TRAUMA

ü                  Nurse doesn’t  need to remove object, just to SECURE IN PLACE, then physician will remove.ü                 

If it is burning chemical; splash the eyes with water and call 911, but if it is a chemical like detergents or nothing burning you can just wash eyes for 15 minutesü              

    Never remove the object, SECURE IN PLACE NOTIFY PHISICIANü                

  CORNEA STAINING TO SEE FOREIGH BODIES IN THE EYE.ü                 

Chemical like burning of eyes do not irrigate with sterile water or saline until medical team arriveü                 

TEACH SPORT INJURY WEAR PROTECTIVE EYEGLASSES ü          Operate on worse eye firstü                  Semi fowlers positionü                  Minimal movement 3-5 days to reduce risk for bleedingü                

  Eye patch for 5-7 days to reduce eye strainingü                 

 headache after eye surgery is serious.  ü                 

Hyphema-hemorrhage in the anterior chamber.  ü             

     May block the pupil and reduce vision if large enough.  ü                  Cycloplegic eye drops and eye patch or eye shield 5-7days.ü                  Penetrating injury has the poorest chance of retaining vision

25 A.

    Penetrating injuries

25. B

Lacerations:

25. C

Foreign bodies

25.D

 Contusion (black eye):

25. E

Hyphema

hemorrhage in the anterior chamber, may block the pupil and
reduce vision if large enough, causing pain and photophobia, hemolysis of
the blood may increase IOP.

 TX bed rest in semi fowler  position,

minimal
head movement no sudden movements for 3-5 days (decrease rebleeding risk)
use cycloplegic eye drops and eye patch/shield for 5-7 days.             

26.

RINNE TUNNING FORK TEST

DEFINITION

ü                  = Rinne test (air conduction) tuning fork is held first against the mastoid bone and then in front of the ear canal.  The patient reports whether the sound is louder behind the ear or next to the ear canal.  When the sound is no longer perceived behind the ear, the fork is moved next to the ear canal until the patient indicates that the sound is no longer heard.  The Rinne test is positive when the patient reports that air conduction is heard longer than bone conduction.  This can indicated normal hearing or a sensorineural loss if the patient hears the tuning fork better by bone conduction, the Rinne test is negative and indicates that a conductive hearing loss is present.  

vs

The Webber test (bone conduction) is the tuning fork on top of the head and you ask which ear they hear from.   the base of an activated tunning fork is held first against the mastoid bone + then in the front of ear canal 0.5-2 inches. The patient report whether the sounds is louder behind the ear ( on mastoid bone) or in the ear canal. Positive  is when pt report that air conduction AC is 2X longer then BC bone conduction.

Ex. If bone cond is heard in 5 sec. then air cond is heard in 10 sec.=> positive=> normal hearing=> sensorineural loss.  If heard better by BC => rinne test is negative =>conduction hearing  loss

28.

MENIERE'S DISEASE

N DX

27.

HEARING IMPAIRMENT  INTERVENTIONS

29.

VERTIGO

ü                  is a sense that the person or objects around the person are moving or spinning and is usually stimulated by movement of the head.  It does not occur when lying down.  

  Spinning ü                           Restrict head movements ü                      

30.

RISK FOR HEARING LOSS

OCUPATIONAL HAZARDS

ENVIRONMENTAL NOISY

31.

NURSING DX HEARING IMPAIRMENT

32.

CONDUCTIVE  VS SENSORINEURAL

ü                  Sensineural ( is permanent)- is caused by impairment of function of the inner ear or the vestibullocochlear nerve CN VIII.  Congenital and hereditary factors, noise trauma during  a period of time, aging (presbycusis), Menieres disease, and ototoxicity can cause sensorineural hearing loss.  (use of myotic drugs can cause this)

   conductive                                vs.                    sensineural       air                                                        impair inner ear  wax                                                      cranial nerves 

 foreign bodies                                        aging 

   otitis media                                            ototoxicity 

       tx- remove wax                                      menieres disease

33.

ear exam

For adults- the top of the auricle is grasped and gently pulled up and backward.  Children- the auricle is grasped and pulled slightly down and backward to straighten the canal.  The hand holding the otoscope is braced against the face for stabilization.

OTOSCOP EXAM:

ADULT       PULL    UP + BACKWARD

CHILD   PULL    DOWN +  BACKWARD