• The content concerns Engage Adult Med/Surg Modules Sensory, Cancer, and Inflammation/Immunity
• The exam date is March 13, 2025

Nursing Process

• Assessment
• Analysis; nursing diagnosis
• Planning
• Implementation
• Evaluation
• Communication/Documentation
• Teaching/Learning
• Culture/Spirituality

Cognitive Level

• Knowledge
• Comprehension
• Application
• Analysis
• Synthesis
• Evaluation

Client Needs

• Management of Care
• Safe/Effective Care Environment
• Health Promotion/Maintenance
• Psychosocial Integrity
• Basic Care & Comfort
• Pharmacological/Parenteral Therapy
• Reduction of Risk Potential
• Physiological Integrity/Adaptation

Pathophysiology of Ménière's Disease

• Ménière's disease primarily results from abnormal fluid buildup in the inner ear
• This fluid accumulation, known as endolymphatic hydrops, increases pressure in the inner ear structures
• Inner ear disruption affects both hearing and balance, causing Ménière's symptoms

Diuretics for Meniere's Disease

• Diuretics like hydrochlorothiazide, spironolactone, and furosemide may be prescribed, they remove excess fluid

Treatment Goals

• Stabilize endolymphatic fluid production to minimize fluid buildup
• Reduce vertigo episodes to improve mobility and safety
• Minimize permanent hearing loss through early symptom management
• Enhance overall quality of life and support ADLs

Impact on Daily Life

• Clients might avoid driving, working, or socializing due to unpredictable vertigo attacks that is related to anxiety and fear
• Safety precautions are critical because of increased fall risk

Common Manifestations

• Vestibular Symptoms: Vertigo, nausea, vomiting, imbalance, cold sweats, trembling
• Auditory Symptoms: Hearing loss, tinnitus, ear fullness/congestion, blurry vision, headaches

Early Signs of an Attack

• Feeling uneasy
• Increased ear pressure

Pharmacological Therapy

• Motion sickness medications: Meclizine (Antivert) and Diazepam (Valium)
• Antinausea medications: Promethazine (Phenergan) and Ondansetron (Zofran)

Long-Term Management

• Diuretics reduces fluid retention: Hydrochlorothiazide, Spironolactone, and Furosemide
• Corticosteroids: Prednisone reduces inflammation
• Vestibular Rehabilitation Therapy: Improves balance

Safety Considerations

• Use assistive devices when needed
• Avoid sudden movements or position changes
• Ensure a clutter-free environment to prevent tripping hazards

Lifestyle Modifications

• Reduce dietary salt to prevent fluid retention
• Limit caffeine and alcohol to avoid exacerbating symptoms
• Smoking cessation improves circulation
• Manage stress with meditation and relaxation techniques
• Adequate sleep and avoid excessive exertion

AMD

• Age-related Macular Degeneration (AMD) is a progressive eye disease that leads to the degeneration of the macula and causes central vision loss
• Dry AMD (Non-Neovascular): Characterized by gradual breakdown of the retina and accumulation of drusen, resulting in gradual central vision loss
• Treatment: No cure, but carotenoids (lutein and zeaxanthin) may help slow progression

Wet AMD Types

• Wet AMD (Neovascular): Involves abnormal blood vessels growing under the retina, which leak fluid and distort vision
• Symptoms: Sudden onset of blurred vision or blind spots

Treatment for Wet AMD

• Anti-VEGF injections: Ranibizumab, aflibercept, brolucizumab administered monthly into the eye
• Photodynamic therapy (PDT): Eliminates abnormal blood vessels

Lifestyle Modifications for AMD

• Encourage smoking cessation and manage chronic conditions to slow AMD progression

Nutrition for AMD Patients

• Encourage diets with: Antioxidants (blueberries, spinach, kale), Omega-3 fatty acids (salmon, flaxseed), and Zinc (red meats, dairy)
• Regular physical activity helps circulation and overall health

Client Education and Monitoring

• Provide resources to help clients quit smoking
• Teach clients to use the Amsler grid at home to monitor central vision changes
• Report any distortion to the healthcare provider immediately

Chronic Condition Management:

• Advise on controlling hypertension, cholesterol, and obesity to decrease risk of AMD progression

Safety Considerations for Fall Prevention

• Due to vision changes, they should take precautions to make sure rugs are secured, paths are clear, and there are handrails installed
• Ensure the environment is well-light, use non-skid mats, avoid open-flame candles/fireplaces, and use color-coded medication labels

Risk Factors for AMD Include:

• Age
• Smoking and UV light exposure
• Hypertension, elevated cholesterol, and obesity
• Genetics and family history
• Light-colored eyes and light skin pigment

Increase AMD risk

• Individuals with chronic cardiovascular or renal health conditions are at increased risk
• Regular eye exams are essential for clients at risk for stroke, myocardial infarction, hyperlipidemia, and hypertension

Retinal Reattachment Pre-Surgical Assessment

• Assess baseline measurements: blood pressure, heart rate, and oxygen saturation

Retinal Reattachment Surgical Options

• Scleral Buckle: silicone band is sewn to the sclera creating pressure from the vitreous pulling on the retina.
• Pars Plana Vitrectomy: removal of that vitreous gel to help the retina reattach

Cancer Screening

• Teaching: Explain the importance of mammograms starting at age 40+ to detect breast cancer early

Cervical Cancer Teaching

• Educate women to start Pap smears at age 21, then every 3 years
• Learning: Patients should know the need for routine screenings, even without symptoms

Colorectal Cancer Learning

• Discuss how early detection can prevent colon cancer or identify it early

Teaching for Lung Cancer

• Advise heavy smokers (ages 55-80) to consider low-dose CT scans