Beruflich Dokumente
Kultur Dokumente
- Ciliary
Body
o Changes
the
shape
of
the
lens
and
secretes
aqueous
humor
o The
aqueous
humor
bathes
and
nourishes
the
lens
&
cornea
o Excess
production
or
decreased
outflow
of
aqueous
humor
can
elevate
intraocular
pressure
above
the
normal
10-21
mm
Hg.
- Lens
-
-
Assessment
of
Visual
System:
- Subjective
Data
o Past
health
history
o Ocular
information
such
as
visual
tests,
family
history,
and
head
or
eye
trauma
o Nonocular
health
problems
such
as
systemic,
cardiac,
or
pulmonary
diseases
o Medications
including
OTC,
eye
drops,
herbal
therapies,
or
dietary
supplements
o Surgery
or
other
procedures,
including
brain
surgery
or
laser
treatments
o Patients
perception
of
the
problem
o Safety
o Allergies
o Hereditary
diseases
and
visual
problems
o Nutritional-metabolic
pattern (Vitamins A, D, E & Beta-carotene)
-
Elimination pattern
Objective
Data
o Physical
Examination
(May
be
as
brief
as
measuring
visual
acuity
or
in-depth
and
require
special
training.
Always
based
on
what
is
appropriate
and
necessary
for
the
specific
patient)
o Snellen
Eye
Chart
(chart
with
the
big
E
at
top)
o Jaegar
Eye
Chart
(hand-held
vision
screener
with
varying
print
sizes)
o Ishihara
Color
Test
(color
vision)
2
Six
Cardinal
Positions
of
Gaze:
Visual
Problems:
- Refractive
Errors:
o Myopia:
nearsightedness
(cant
see
far
away)
o Hyperopia:
farsightedness
(cant
see
close
up)
o Presbyopia:
farsightedness
due
to
aging
o Astigmatism:
irregular
corneal
curvature
o Aphakia:
no
lens
- Conjunctivitis:
o Extraocular
disorder
o Infection
or
inflammation
o Bacterial
(pink
eye)
or
viral
(contaminated
swimming
pools)
o Can
be
caused
by
a
chlamydial
infection
(adult
inclusion
conjunctivitis)
o Allergic
conjunctivitis
(defining
symptom
is
itching)
- Keratitis
o Corneal
inflammation
or
infection
o Bacterial
or
viral
o Keratoconjunctivitis
involves
the
conjunctiva
&
cornea
o Herpes
simplex
virus
(most
common
infectious
cause
of
corneal
blindness)
o Herpes
zoster
opthamicus
(caused
by
varicella-zoster
virus
o Causes:
Ocular
trauma,
homemade
or
purchased
lens
care
solutions
or
cases,
exophthalmos
or
masses
behind
eye
Corneal
Ulcer
o Tissue
loss
caused
by
infection
of
the
cornea
o Aggressive
treatment
necessary
to
avoid
permanent
vision
loss
Dry
Eye
Disorders
o Keratoconjunctivitis
sicca
(dry
eyes)
Strabismus
o The
PT
cannot
consistently
focus
2
eyes
simultaneously
on
the
same
object
(crosseyed)
o Esotropia
(eye
deviates
in)
o Exotropia
(eye
deviates
out)
o Hypertropia
(eye
deviates
up)
o Hypotropia
(eye
deviates
down)
o Primary
complaint
is
double
vision
Retinopathy
o Slow
or
rapid
process
of
microvascular
damage
to
the
retina
o Common
complication
in
uncontrolled,
long-standing
diabetes
(diabetic
retinopathy)
o Hypertension
can
create
vascular
blockages
in
retinal
blood
vessels
(hypertensive
retinopathy)
o Retinopathy
is
irreversible
Retinal
Detachment
o Almost
all
patients
become
blind
in
effected
eye
if
untreated
o Symptoms:
light
flashes,
floaters,
or
rings
in
vision
are
painless
o Surgical
intervention
is
indicated
Age-Related
Macular
Degeneration
o Is
most
common
cause
of
central
vision
loss
in
older
adults
o Nonexudative
is
slower
to
progress
&
more
common
(dry)
o Exudative
is
more
severe
&
rapid
(wet)
Cataract
o An
opacity
(cloudiness)
within
the
lens
o Leading
cause
of
blindness
o Most
common
surgical
procedure
for
those
aged
over
65
o Factors:
Age,
blunt
trauma,
congenital,
UV
light
exposure,
long-term
corticosteroid
use,
ocular
inflammation
o Senile
cataract
(most
common
type;
age
related)
o S/S:
decrease
in
vision,
abnormal
color
perception
(color
not
as
bright
or
sharp),
glaring
of
vision
o No
nonsurgical
cure
o Surgical
therapy:
antianxiety
medication
before
local
anesthesia;
cataract
extracted
&
sutured;
corticosteroid
&
ABT
ointment
applied
with
protective
shield
o Visual
acuity
improves
immediately
after
surgery
o There
should
be
no
pain
after
surgery
(notify
MD
immediately
if
PT
reports
pain)
Glaucoma
o A
group
of
disorders
characterized
by:
increased
IOP
&
consequences
of
elevated
pressure,
optic
nerve
atrophy,
peripheral
visual
field
loss
o 2nd
leading
cause
of
blindness
4
-
The
Human
Ear:
o Rinne
Test
The
examiner
holds
the
base
of
a
tuning
fork
against
the
mastoid
bone
(BCbone
conduction
of
sound)
and
notes
the
time.
When
the
sound
is
no
longer
perceived
behind
the
ear
(BC),
the
time
is
noted
once
again
and
the
still
vibrating
fork
is
moved
0.5
to
2
inches
in
front
of
the
ear
canal
(ACair
conduction
of
sound).
Have
the
patient
report
when
the
sound
next
to
the
ear
canal
(AC)
is
no
longer
heard
and
note
the
time.
Normally,
the
sound
is
heard
twice
as
long
in
front
of
the
ear
as
it
is
on
the
bone.
The
Rinne
test
is
positive
when
the
patient
reports
that
air
conduction
(AC)
is
heard
longer
than
bone
conduction
(BC).
This
can
indicate
a
sensorineural
hearing
loss.
If
the
patient
hears
the
tuning
fork
better
by
bone
conduction,
the
Rinne
test
is
negative,
which
suggests
a
conductive
hearing
loss.
Whisper
Test:
o Stand
12-24
in
to
the
side
of
the
patient
&
after
exhaling,
speak
in
a
low
whisper
o Test
each
ear
separately
o The
ear
not
being
tested
is
covered
by
the
patient
Audiometry
o The
audiometer
produces
pure
tones
at
varying
intensities
to
which
the
patient
can
respond.
o Hertz
(Hz)
is
the
unit
of
measurement
used
to
classify
the
frequency
of
a
tone
o Decibels
(dB)
measures
the
intensity
or
strength
of
a
sound
wave
Auditory
Problems:
- Presbycupsis:
o Hearing
loss
as
a
result
of
aging
o Factors:
noise
exposure,
systemic
diseases,
poor
nutrition,
ototoxic
drugs,
pollution
exposure
over
the
lifespan
o Is
greater
for
high
pitched
sounds
- Tinnitus:
o Ringing
in
the
ears
o Prevalence
expected
to
rise
as
life
span
increases
- Trauma
o Blows
to
the
ear
can
cause
conductive
hearing
loss
o Head
trauma
that
injures
the
temporal
lobe
of
the
cerebral
cortex
can
impair
the
ability
to
understand
the
meaning
of
sounds
- External
Otitis
o Involves
inflammation
or
infection
of
the
epithelium
of
the
auricle
&
ear
canal
o Swimmers
Ear
o Ear
pain
(otalgia)
is
one
of
the
first
signs
of
external
otitis
o Muffled
hearing,
drainage
&
fever
(occurs
when
the
infection
spreads
to
surrounding
tissues)
o Moist
heat,
mild
analgesics
&
topical
anesthetic
drops
usually
control
the
pain
- Otitis
Media
o Infection
of
the
middle
ear
o S/S:
pain,
fever,
malaise
&
reduced
hearing
o Acute
Otitis
Media:
common
in
children
-
-
-
o Otitis
media
with
effusion:
is
an
inflammation
of
the
middle
ear
with
a
collection
of
fluid
in
the
middle
ear
space
Otosclerosis
o Is
a
hereditary
autosomal
dominant
disease
o Results
in
conductive
hearing
loss
o Examination
may
reveal
a
reddish
blush
of
the
tympanum
(Schwartzs
Sign)
Mnires
Disease
o Is
characterized
by
symptoms
caused
by
inner
ear
disease,
including
episodic
vertigo,
tinnitus,
fluctuating
sensorineural
hearing
loss,
&
aural
fullness.
o Symptoms
usually
begin
between
30-60
years
of
age
o The
cause
is
unknown
o Attacks
may
last
hours
or
days
&
may
occur
several
times
a
year
Benign
Paroxysmal
Positional
Vertigo
o BPPV
is
a
common
cause
of
vertigo
o Free
floating
debris
in
the
semicircular
canal
causes
vertigo
with
specific
head
movements
o Treatment:
Epley
maneuver
(ear
debris
is
moved
from
one
area
to
another)
Acoustic
Neuroma
o Is
a
unilateral
benign
tumor
that
occurs
where
the
vestibulocochlear
nerve
enters
the
internal
auditory
canal.
o Symptoms
begin
between
40-60
years
of
age
o Removal
of
small
tumors
preserve
hearing
o Removal
of
large
tumors
can
cause
permanent
hearing
loss
Conductive
Hearing
Loss
o Occurs
when
conditions
in
the
outer
or
middle
ear
impair
the
transmission
of
sound
through
air
to
the
inner
ear
o Causes:
Otitis
media
with
effusion,
impacted
cerumen,
perforation
of
the
TM
Sensorineural
Hearing
Loss
o Is
caused
by
impairment
of
function
of
the
inner
ear
or
the
vestibulocochlear
nerve.
o Causes:
congenital,
hereditary,
noise
trauma
over
time,
aging,
Mnires
Disease,
ototoxicity,
Pagets
disease,
DM,
bacterial
meningitis
o The
main
problems
are
the
ability
to
hear
sound
but
not
to
understand
speech
Central
Hearing
Loss
o Involves
an
inability
to
interpret
sound,
including
speech,
because
of
a
problem
in
the
brain
(CNS).
Functional
hearing
Loss
o May
be
caused
by
an
emotional
or
psychologic
factor
Classification
of
Hearing
Loss
o Normal
hearing:
0-15
dB
o Profound
Deafness:
>90
(congenitally
deaf)
Drug
therapy:
o Sandostatin
(reduces
GH
levels)
o Given
SQ
3
times
a
week
o GH
levels
are
measured
every
2
weeks
to
guide
dosing
-
-
-
-
10
Diagnostic:
o Simultaneous
measurements
of
urine
&
serum
osmolarity
o Dilutional
hyponatremia:
serum
sodium
less
than
134
mEq/L
o Normal
sodium
levels:
135-145
Treatment:
o Fluid
restriction
o Position
head
of
bed
flat
or
elevated
no
more
than
10
to
enhance
venous
return
o IV
hypertonic
saline
solution
(3-5%)
may
be
slowly
administered
(monitor
B/P)
o Loop
Diuretic
(Lasix)
o Declomycin:
blocks
the
effect
of
ADH
Posterior
Pituitary:
Diabetes
Insipidus:
- Deficiency
of
production
or
secretion
of
ADH
- The
decrease
in
ADH
results
in
fluid
&
electrolyte
imbalances
- Causes
increased
urine
output
&
increased
plasma
osmolality
- Characterized
by
polydipsia
(excessive
thirst)
&
polyuria
(excessive
urination)
o Urine
output
of
2-20
liters/day
o Very
low
specific
gravity
<1.005
o Hypernatremia
caused
by
pure
water
loss
(irritability
&
mental
dullness)
o Fatigued
from
nocturia
(excessive
urination
during
the
night)
o Generalized
weakness
- If
oral
fluid
intake
cannot
keep
up
with
urinary
losses,
severe
dehydration
results
o Poor
skin
turgor
o Hypotension
o Tachycardia
o Hypovolemic
shock
- Diagnostic
Studies:
Water
Deprivation
Test
o Before
the
test,
body
weight,
urine
osmolarity,
volume
&
specific
gravity
are
measured
o Patient
is
deprived
of
water
for
8-12
hours
o Patient
is
given
desmopressin
(increases
ADH)
SQ
or
nasally
o Patients
with
DI
exhibit
a
drastic
increase
in
urine
osmolarity
&
significant
decrease
in
urine
volume
o Nurse
will
want
to
stop
test
immediately
if
dehydration
symptoms
occur
- Treatment:
o Increase
fluids
o Hypotonic
IV
solutions
(D5W)
o Monitor
blood
sugar,
B/P,
heart
rate,
urine
output,
S/S
of
dehydration
o Monitor
intake
&
output
o Monitor
daily
weights
to
determine
fluid
volume
status
o Low-Sodium
diet
(3g/day)
o Desmopressin
(DDAVP):
ADH
hormone
replacement
(SQ
or
nasal
spray)
Anterior
Pituitary:
Hyperthyroidism:
- A
sustained
increase
in
synthesis
&
release
of
thyroid
hormones
by
thyroid
gland
11
-
-
o Has
a
delayed
response,
maximum
effect
may
not
be
seen
for
up
to
3
months
o Administered
on
an
outpatient
basis
o Pregnancy
test
is
done
before
initiation
of
therapy
o May
cause
dryness
&
irritation
of
the
mouth
&
throat
o Iodine
is
mixed
with
water
or
juice,
sipped
through
a
straw
&
administered
after
meals
Home
precautions
for
RAI:
o Flush
2-3
times
after
toilet
use
o Separately
laundering
towels,
bed
linens,
&
clothes
daily
o Do
not
prepare
food
for
others
that
require
prolonged
handling
with
bare
hands
o Avoid
being
close
to
pregnant
women
or
children
for
7
days
after
therapy
Nutritional
Therapy:
o A
high
caloric
diet
(4,000-5,000/day)
o Six
full
meals
a
day
&
snacks
high
in
protein
&
carbs
o Avoid
highly
seasoned
&
high-fiber
foods
(stimulate
the
GI
tract)
o Avoid
caffeine
containing
liquids
(increase
restlessness
&
sleep
disturbances)
Thyroidectomy:
o Removal
of
the
thyroid
gland
o Patient
is
given
antithyroid
drugs,
iodine
&
beta
blockers
to
achieve
a
euthyroid
state
o Oxygen,
suction
equipment,
&
a
tracheostomy
tray
should
be
readily
available
in
the
patients
room
o Pre-op
Teaching:
! Importance
of
performing
leg
exercises
! How
to
support
the
head
while
turning
in
bed
! Range
of
motion
exercises
of
the
neck
! Talking
is
likely
to
be
difficult
a
short
time
after
the
surgery
! Routine
post
op
care
such
as
IV
infusions
o Post-op
Complications:
! Hypothyroidism
! Damage
or
accidental
removal
of
parathyroid
glands
! Hemorrhage
! Injury
to
laryngeal
nerve
(vocal
cord
paralysis)
(both
cords=spastic
airway
obstruction)
! Laryngeal
Stridor
(harsh,
vibatory
sound
during
inspiration
&
expieration)
! Thyrotoxic
crisis
! Infection
o Post-op
Care:
! Assess
Q2hrs
for
signs
of
hemorrhage
or
tracheal
compression
(irregular
breathing,
neck
swelling,
frequent
swallowing,
sensations
of
fullness
at
the
incision
site,
choking,
blood
on
the
anterior
or
posterior
dressings)
! Place
the
pt
in
semi-Fowlers
position
&
support
head
with
pillows.
! Avoid
flexion
of
the
neck
&
any
tension
on
the
suture
line
! Monitor
vital
signs
&
calcium
levels
! Check
for
tetany
(Trousseaus
&
Chvostek
Signs)
! Control
post-op
pain
by
giving
medications
13
Anterior
Pituitary:
Hypothyroidism:
- A
deficiency
of
thyroid
hormone
that
causes
a
general
slowing
of
the
metabolic
rate
- Iodine
deficiency
is
the
most
common
cause
- Cretinism
(hypothyroid
in
infants)
-
Diagnostic
Studies:
o Serum
TSH
levels
help
determine
the
cause
of
hypothyroidism
o TSH
the
defect
is
in
the
thyroid
o TSH
the
defect
is
in
the
pituitary
or
hypothalamus
o Cholesterol
&
triglycerides
o Anemia
o Creatine
kinase
Complications:
o Myxedema
Coma
! Medical
emergency
! Unresponsiveness
or
lethargy
o Treatment
of
myxedema
coma:
! Vital
functions
must
be
supported
! IV
thyroid
hormone
replacement
administered
Treatment:
14
Anterior
Pituitary:
Hyperparathyroidism:
- An
increased
secretion
of
parathyroid
hormone
(PTH)
- PTH
helps
regulate
serum
calcium
- serum
calcium
levels
- Excessive
levels
of
PTH
usually
lead
to
hypercalcemia
&
hypophosphatemia
- Clinical
Manifestations:
o Muscle
weakness
o Loss
of
appetite
o Constipation
o Fatigue
o Osteoporosis
o Fractures
o Kidney
stones
- Complications:
o Renal
Failure
o Pancreatitis
o Cardiac
changes
o Long
bone,
rib
&
vertebral
fractures
- Diagnostic
Studies:
o PTH
levels
o Serum
calcium
levels
>10mg/dL
- Surgical
Therapy
o Criteria
for
surgery:
! Serum
calcium
levels
! Hypercalciuria
! Markedly
reduced
bone
mineral
density
! Those
under
age
50
o Autotransplantation:
15
Anterior
Pituitary:
Hypoparathyroidism:
- Inadequate
circulating
PTH
- Characterized
by
hypocalcemia
- Clinical
Manifestations:
o Painful
tonic
spasms
of
smooth
&
skeletal
muscles
can
cause
dysphagia
&
laryngospasms,
which
compromise
breathing
o Lethargy
o Anxiety
o Personality
changes
o Tetany
- Treatment:
o Goal:
treat
acute
complications,
maintain
normal
calcium
levels,
prevent
long-term
complications
o Give
IV
calcium
chloride,
calcium
gluconate
slowly
o Use
ECG
monitoring
during
IV
therapy
o Rebreathing
may
partially
alleviate
acute
neuromuscular
symptoms
o Oral
calcium
supplements
are
usually
prescribed
o Vitamin
D
is
used
to
enhance
intestinal
calcium
absorption
o Tell
the
PT
to
avoid
foods
containing
oxalic
acid
(spinach,
rhubarb)
o Calcium
meal
plan
(dark
green
vegetables,
soybeans,
tofu)
Anterior
Pituitary:
Cushing
Syndrome:
- A
clinical
condition
that
results
from
chronic
exposure
to
excess
corticosteroids,
particularly
glucocorticoids
- Manifestations:
16
Diagnostic
Studies:
o Plasma
cortisol
levels
may
be
elevated
o A
24-hr
urine
collection
for
free
cortisol
is
done
o Normal
urine
cortisol
levels
(80-120mcg/24hr)
o If
results
are
borderline
a
low-dose
dexamethasone
suppression
test
is
done
Treatment:
o Goal:
to
normalize
hormone
secretion
o Surgical
removal
is
the
standard
treatment
o Mitotane
(Lysodren)
suppresses
cortisol
production
when
surgery
is
contraindicated
Anterior
Pituitary:
Adrenocortical
Insufficiency:
- Hypofunction
of
the
adrenal
cortex
(Addisons
Disease)
- Lack
of
pituitary
ACTH
secretion
- Clinical
Manifestations:
o Do
not
become
evident
until
90%
of
the
adrenal
cortex
is
destroyed
o Manifestations
have
a
slow
onset
17
Complications:
Addisonian
Crisis
(acute
adrenal
insufficiency)
o Life-threatening
emergency
o Insufficient
adrenocortical
hormones
o Triggered
by:
! Stress
! Sudden
withdrawal
of
corticosteroid
hormone
therapy
! Adrenal
surgery
! Sudden
pituitary
gland
destruction
o Symptoms:
! Postural
hypotension
! Tachycardia
! Dehydration
! Hyponatremia
! Hyperkalemia
! Hypoglycemia
! Fever
! Weakness
! Confusion
! Severe
vomiting
! Diarrhea
! Abdominal
Pain
Diagnostic
Studies:
o Depressed
serum
&
urinary
cortisol
levels
18
Treatment:
o Hormone
therapy
o Hydrocortisone
(mineralcorticoid
&
glucocorticoid
properties)
o Fludrocortisone
(Florinef)
mineralcorticoid
o Increase
salt
intake
in
diet
Patient
Teaching:
o The
PT
should
carry
an
emergency
kit
at
all
times
! 100mg
IM
hydrocortisone
! Syringes
! Instructions
for
use
Pheochromocytoma:
- Tumor
in
the
adrenal
medulla
- Excess
production
of
catecholamines
(epinephrine
&
norepinephrine)
- Manifestations:
o Severe
hypetension
o Severe
pounding
headache
o Tachycardia
with
palpitations
o Profuse
sweating
o Unexplained
abdominal
or
chest
pain
o Attacks
may
last
from
a
few
minutes
to
several
hours
- Diagnostic
Studies:
o Measurement
of
urinary
fractionated
metanephrines
(catecholamine
metabolites)
o Usually
done
as
a
24-hr
urine
collection
- Treatment:
o Surgical
removal
of
tumor
o Beta
blockers
are
required
pre-op
to
control
B/P
&
to
prevent
an
intraoperative
hypertensive
crisis
19