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Internal
Structures
Outer Layer
Sclera
Cornea
Middle Layer
Choroid
Ciliary Body
Iris
Pupil
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Inner Layer
Retina
Lens
Vitreous
humor
Optic disk
Macula Lutea Aqueous
humor
Canal of
Schlemm
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MEASUREMENT OF VISION
Visual Acuity
Snellens Chart
Confrontational test
Extraocular Muscle Function
Six cardinal position of gaze
Color Vision
Ishihara Chart/Plates
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DIAGNOSTIC TESTS
Slit lamp
Tonometry Opthalmoscopic Examination
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CATARACTS
Causes:
Aging Process
Inherited
Injury
Endocrine disorders
Signs & Symptoms
Gradual or abrupt?
Painful or painless? opaque or cloudy white pupil
decreasing visual acuity
progressive nearsightedness
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Diagnostic Study
Slit lamp examination
Opthalmoscopic examination
Surgical Management
Intracapsular Cataract Extraction
(ICCE)
Extracapsular Cataract
Extraction (ECCE)
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Pharmacologic Management
Mydriatrics
Epinephrine, adrenaline,phenylephrine HCl (Neo-
Synephrine, Ocu-phrin)
Cycloplegics
Atropine SO4 (Atropisol),
scopolamine hydrobromide
(Isopto-Hyoscine),
cyclopentolate (Cyclogyl) Acetazolamide, Mannitol
Antibiotics
Mild Analgesics
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RETINAL DETACHEMENT
Causes
Trauma
Retinal degeneration
Tumor in the eye
Hemorrhage
Cataract surgery Myopia
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Signs & Symptoms
Painful or Painless?
Diagnostic study
Opthalmoscopic examination
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Implementation
Provide bed rest
Cover eyes
Speak before approaching
Position head as prescribed Protect from injury
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Surgical Procedures
Scleral Buckling
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Post-op nursing management
eyepatch
Monitor for complication
Wear dark glasses during the day
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GLAUCOMA
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Types:
Chronic Open-Angle Glaucoma
Primary / simple / chronic
^ 3050 mmHg
Signs & symptoms:
No early s/s
Insidious visual impairment
Diminished accommodation &
loss of peripheral visionHalos around lights
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Acute Closed-Angle / Narrow
Angle Glaucoma
50-70 mmHg Signs & symptoms:
Transitory attacks of diminished
visual acuity Halos around lights
Excruciating pain
________, ________, _________ Blurred, cloudy vision
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Management:
Topical Miotics pilocarpine (Pilocar), Carbachol
Topical Beta-blockers betaxolol (Betoptic), metipranol
(Optipranolol), timolol (Timoptic)
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Oral Carbonic Anhydrase Inhibitors
reduces production of AH
acetazolamide (Diamox), may cause malaise, anorexia &
fatigue but do not d/c drug.
Osmotic diuretic / Hyperosmotic
agents
mannitol (Glycerol), Glycerine
(Glyrol, Osmoglyn)
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Diagnostic Studies:
Otoscopic Examination
Weber test
Rinne test
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Rombergs test
Caloric test
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MENIERES DISEASE
(Endolymphatic Hydrops)
Causes:
Unknown
May be related to the degenerationof cochlear hair cells.
Hypernatremia
Emotional disorders
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Signs & Symptoms
3 Cardinal signs: ____________,____________, __________
nausea/vomiting, nystagmus, severe
headache Warning sign of an attack:
_____________________________
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Management:
Furstenburg Diet
Vasodilators, Antihistamines, Mild
sedatives Diuretics
During attack: assume comfortable
position
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OTOTOXIC SUBSTANCES
Diuretics: ____________
Chemotherapeutic agents:
Cisplatin(Platinol), nitrogenmustard
Anti-inflammatory agents: __________
Antibiotics: _________Chemicals: alcohol, arsenic,
nicotine
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Anatomy & Physiology
External Structures:
Auricle / Pinna
External Auditory Canal
Tympanic membrane (Eardrum)
Middle Ear
Ossicles
Mallus (Hammer) Incus (Anvil)
Stapes (Stirrups)
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Eustachian Tube
Inner Ear Vestibule
Semicircular canals
Utricle & Saccule
Cochlea
Organ of Corti
Fluids
Perilymph
Endolymph
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OTOSCLEROSIS
Risk Factors:
Familial tendency Women
Caucasian
Signs & Symptoms:
gradual, progressive hearing loss
constant tinnitus
Rinne test / Weber test
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Management:
Stapedectomy
watch for signs of infxn
Antibiotics for prophylaxis
Bed rest
Do not blow nose for at least 2
weeks
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The nurse is evaluating a child for haring
loss. In reviewing the childs history,which finding would not be associated
with a hearing loss?
a. Prenatal problem of rubella
b. Repeated, chronic ear infection
c. Taking penicillin and cephalosporin
medicationd. Exposure to high-intensity sound
waves.
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A 3-year old child had a myringotomy about a
week ago. The mother call the nurse and
report that one of the tubes fell out. After thenurse makes an appointment for the child to
be seen by the physician, what would be
important for her to tell her mother?
Observe for any purulent drainage from theear.
Rinse the tube in soapy H2O and keep it.
Do not allow any H2O to get into the childsear.
Do not allow the child to play outside.
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INTEGUMENTARY
SYSTEM
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DECUBITUS ULCER
RISK FACTORS:1. Immobility
2. Aging
3. Moisture
4. Inadequate hydration5. Pyrexia
6. Dryness
7. Incontinence
8. Cognitive impairments9. Equipment
10. Shearing force or friction
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S T A G E S
STAGE I
STAGE II
STAGE III
STAGE IV
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MANAGEMENT
1. Positioning & Supportive device
2. Diet
3. Adequate hydration4. Massage bony prominences
5. Apply Dressings
6. Antibiotic therapy7. Debridement
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S T A G E S
STAGE I
STAGE II
STAGE III
STAGE IV
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ETIOLOGY
Thermal
Chemical
Electrical
Radiation
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PATHOPHYSIOLOGY
TYPES:
Superficial Burn (1st degree)
Layer:
Pain: Characteristics:
Healing:
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Partial-thickness Burns (2nd degree)
Layers:
Pain: red to pale ivory moist skin w/ blisters
Healing:
Full Thickness Burns (3rd degree)
Layers:
Pain:
Skin: white, cherry red, black; - blisters;dry, hard, leathery appearance.
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Cardiovascular Response
Renal & GIT
Respiratory
Immune System
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Nursing Management:
Provide Emergency Care Eliminate source of burn
Cool the burn for several mins.
remove restrictive objects.
cover wound
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apply ABC of trauma
Assess for & treat smoke inhalation
injury Assess for & treat carbon monoxide
poisoning
prevent shock
monitor acid-base balance &
electrolyte
NPO
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Wound Care
Wound Cleansing&HydrotherapyBurn Wound Coverings
Biologic Dressings:
Amnion Allograft
Xenograft
Biosynthetic Dressing Biobrane
Autograft
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Care of Graft Site:
immobilize graft site
keep site free from pressure remove exudates
monitor foul-smelling drainage
use support garments & splints Topical Antimicrobials
silver sulfadiazine (Silvadene)
mafenide acetate 10% cream
silver nitrate
Metabolic Support
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Estimate Burn Size:
Rule of Nines
Lund & Browder
Promote optimum recovery
Wound management Physical Therapy
Pain Management
Morphine SO4 Meperidine (Demerol)
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Which intervention is inappropriate for a
client with severe burns?
a. Administration of IM pain medications
b. Oxygen therapy
c. Aggressive fluid resuscitation
d. Remove restrictive clothing
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A client arrives at the burn center after
sustaining a serious burn injury. The
burned area is white and leathery with no
blisters. What is the best classification?
a. First degree burn injury
b. Superficial partial thickness burn injury
c. Deep partial thickness burn injury
d. Third degree burn injury
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A client has just arrived at the emergency
department after sustaining a major burn
injury. Which of the following metabolicalterations is expected during the first 8
hours post-burn.
a. Hyponatremia and hypokalemia
b. Hyponatremia and hyperkalemia
c. Hypernatremia and hypokalemia
d. Hypernatremia and hyperkalemia
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Providing adequate nutrition is essential for
a burn client. Which of the following
statements best describes the nutritionalneeds of a burn client?
a. A child needs 100 cal/kg during
hospitalization
b. The hypermetabolic stage after a burn
injury leads to poor healing
c. Caloric needs can be lowered by
controlling environmental temperatured. Maintaining a hypermetabolic rate will
lower the childs risk for infection
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A client suffered a thermal burn injury causedby inhalation of steam. The clients mouthis edematous, and the nurse notes blistersin the clients mouth. Based on this data,
the nurse monitors the client most closelyfor:
a. Difficulty swallowing
b. pain
c. Fluid loss
d. Wheezing