Cataracts: what are you going to do, what are you going to see, what is the treatment
Cataracts occur as the opacity of the lens becomes cloudy or turns a yellowish brown color,
distorting the light passing through to the retina
The lens is made of water and protein; when the protein clumps ...
PN2 Exam 3 Study Guide
ARTICLE: Seizure (new and improved in the last two years)
Cataracts: what are you going to do, what are you going to see, what is the treatment
Cataracts occur as the opacity of the lens becomes cloudy or turns a yellowish brown color,
distorting the light passing through to the retina
The lens is made of water and protein; when the protein clumps together this produces
the cloudiness
When the lens develops the yellowish brown color it often results in color distortion
Symptoms include cloudiness or blurriness, reduced night vision, and color distortion
or faded colors
Management for patients with cataracts starts with adjusting the corrective lens as
frequently as necessary to ensure optimal vision
Surgical treatment for cataracts begins when vision is sufficiently impaired to interfere
with ADLs
o There are two types of surgery: phacoemulsification and extracapsular surgery
o Cataract surgery is done almost exclusively as an outpatient procedure
o Preoperative nursing care includes preop history and physical, including
medication usage, administration of eye drops to dilate the pupil and cause
vasoconstriction, and patient education
o Oral medications may be given in the preop phase to reduce intraocular pressure,
such as acteazol amide (Diamox, Acetazolam)
o During the intraop procedure, the cataract is removed, and an IOL is placed in most
patients
o Postop care usually includes use of eye drops, including a steroid and antibiotic
placed subconjunctivally
o The eye is usually left unpatched, and the patient discharged home
o Emphasize the postop care of eye drop instillation
o The postop period should be relatively free of complication, and pain or swelling
are generally not expected. If pain with nausea and vomiting should occur, notify
the ophthalmologist
Rheumatoid Arthritis: plan of care, what are you going to do for them, what are you
going to see, help alleviate it, are they going to get better (is it going to go away), what will
work for them, what will not
Planning and Implementation:
Expected outcomes include preserving the individual’s participation in daily activities,
maintain pain at a level that permits participation in self care; being able to balance rest
and activity; adhering to the therapeutic regimen; and coping effectively with the
numerous psycho social spiritual impacts of the disease
The nurse must be knowledgeable of the latest drug safety information
Vigilant assessment of the patient’s increased susceptibility to infections and toxic
effects of immunosuppressive therapy to organs and tissues is essential
, The goals of treatment focus on managing pain and reducing inflammation, promoting
remission, increasing ADL function abilities, and helping individuals to cope with
disabilities
Progression of the disease can be slowed with early aggressive treatment
Multidisciplinary approaches are used, including muscle strengthening, ROM, and
activities to prevent imbalance and the risk of further injury because of falls
Water treatment
Applications of heat or cold and analgesic ointments to the affected areas often provide
pain relief, however, massage can aggravate the inflammation in the acute inflamed
joints
Inmersion of the hands in warm paraffin baths followed by hand exercises is beneficial
in relieving pain and stiffness
Acupuncture, yoga, guided imagery, and therapeutic touch
Surgeries, such as tendon transfer, surgical removal of the synovia in the affected joints,
fusion of a joint, arthroplasty, and joint replacement
Nutrition:
Weight loss is often associated with RA related to several factors: loss or change of
appetite because of the stress of the disease or prescribed medications, inability to
prepare meals secondary to loss of strength in hands or decreased stamina to prepare
the meals, and depression because of the impact of a chronic and debilitating disease
Recommended nutritional intake includes use of monounsaturated fats found in olive
oil and avocados. Foods with omega 3 fatty acids, such as walnuts, fish, eggs, grass fed
beef
Pharmacology:
Table 42-2
Assessment with Clinical Manifestations
Common early clinical manifestations include diffuse musculoskeletal pain, low grade
fever, possible anorexia, and loss of weight
Later, articular (within the joint) manifestations include synovitis, which is
inflammation of the synovial capsule that causes escape of synovial fluid into the
synovial capsule
o Subsequent hypertrophy and symmetrical joint deformity (particularly wrists,
hands, and knees occurs)
Pain, muscle spasms, and weakness, because of contractures of muscles, tendons, and
ligaments, and muscle and soft tissue damage greatly impact the person’s ADLs
Extra articular manifestations that can occur at any time during the course of the
disease include Sjogren’s syndrome (a chronic inflammatory eye disorder), pulmonary
fibrosis, pericarditis, nerve compression, and vasculitis
Development of non-tender rheumatoid nodules that are made up of granulation tissue
surrounding a core of fibrous debris can occur in the subQ tissue and even in visceral
organs, such as the lungs and heart
Stiffness and diminished function after prolonged activity, especially on arising in the
morning, are hallmarks of the progressive severity of the disease
, The person self limits motion, usually by holding the extremity in a flexed position,
which may result in contractures that further contribute to decreased joint function
Diagnosis:
Rheumatology Criteria:
o Morning stiffness lasting more than one hour
o Arthritis of three or more joint areas
o Arthritis of hand joints
o Symmetrical arthritis
o Rheumatoid nodules over extensor surfaces or bony prominences
o Serum rheumatoid factors
o Radiographic changes
Lab values that are elevated:
o Antimitochonrial antibody (AMA)
o Antinuclear antibodies (ANA)
o Antistreptolysin O (ASO)
o Complement C3
o C-reactive protein
o Lupus erythematous cell preparation (LE prep)
Asthma: treatment, what should the patient do for themselves in their home environment
Triggers: Table 33-6
Treatment:
Contact dermatitis: coming from the inside out (itching), educate, sell them on the
education
Contact dermatitis is categorized into two groups: irritant and allergic
Irritant contact dermatitis results when the skin comes in contact with substance in the
environment that acts as an irritant
o It is a nonimmunological response to the irritant that is dependent on the person’s
ability to maintain the normal epidermal barrier
o The extent of the dermatitis is related to the exposure time and concentration of the
irritant
o Characterized by erythema, blister formation, erosions, scaling, and drying and
crusting of skin, irritant contact dermatitis damages the barrier component of the
skin and can be either acute or chronic
o Mild irritants cause drying, erythema, and fissuring
o Chronic exposure to the irritant causes thickening of the epidermis and eczematous
inflammation
o Identification of the irritant is critical to treatment
Allergic contact dermatitis is an inflammatory response to an antigen that follows
absorption of that antigen into the skin; in other words, allergic contact dermatitis is
delayed hypersensitivity reaction
o The person will not have a reaction with the first exposure, but their immune
system will recognize the antigen during the sensitization phase and mark, or
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