Foundations Study Sheet

Foundations Study Sheet

Lead Poisoning:

• Excessive accumulation of lead in blood
• Causes:
• may be exposed by food, air, or water, dust or soil
• can enter though ingestion or inhalation or through placental transmission
• most common route is PO from paint chips, pottery, or ceramics
• it affects erythrocytes, bones and teeth, organs and tissues, including brain and nervous system;most serious consequences involve the CNS
• Screening:
• recommended for children 1-2 years olds; at risk children tested sooner
• any child before 3 and 6 that has not been screened should be tested
• Blood lead level test: (per NCLEX prep book)
• < 10: reasses in one year or sooner if exposure status changes
• 10-14: provide education, follow up testing, social service referral for home assessment
• 15-19: all above plus on follow up initiate actions for 20-44 level
• 20-44: provide clinical coordination of care and clinical management, treatment, environmental investigation, lead hazard control
• 45-69: clinical management within 48 hours, including treatment, investigation, and hazard control
• > 70: medical treatment provided immediately, pluss investigation and hazard control
• Blood level test (per Excelsior):
• at 10 -14 provide education and follow up services
• at 15-19 provide education and follow up services
• at 20 - 44 coordinate services and include environmental control
• at 45 - 69 chelation therapy should begin
• Chelation therapy removes lead from the circulating blood and from some organs and tissues but does not counteract any effects of the lead
• Homes built before 1960 are at risk for lead paint

Community Education:

• First, inform officials that you are planning an educational program and get their approval
• Second, assess the knowledge of the group you will be educating
• Invite a health worker to attend
• Fourth, create written material such as brochures to distribute

When home care is not being performed by care givers:

• first try to figure out the reason why care is not being provided
• then explain the importance of the care

Hispanic Culture/End of Life Care:

• the patient is protected from the prognosis
• the family would rather take full responsibility to care for the pt than to ask for assistance
• funerals are very important
• patients may refuse pain meds in effort to be strong

End of Life Care/Organ Donation:

• organ donation does not delay funeral preparations
• the casket can remain open
• there is no cost to the family
• almost all organs and tissues can be donated

Fisher and Mitchell (1998)

• exploring "meaning, relationships, and hopes with clients creates new self-perceptions for clients"

Forbes (2001)

• studied older adults and found the concepts of mastery and self confidence, and that knowledge of resources available to individual is important to one's health and wellbeing

End of Life Care/ Impending Death:

• the last systems to shut down will be respiratory and circulatory and will progressively slow until death
• respiratory is most distressing for parents to see decline
• anticholinergics can help to dry secretions
• the GI system will begin to malfunction as blood is shunted away from the system (this is where foods such as soups and liquids come in as the patient becomes less able to digest proteins and fiber)
• difficulty swallowing may be seen as a sign of GI malfunction and is considered an earlier sign of impending death

Sensory Impairment/ Pharmacology

• Furosemide (Lasix) at high doses over several years can cause irreversible hearing loss
• Miotics 
• are used to lower IOP
• cause contraction of ciliary muscle
• two types: direct acting (pilocarpine) and indirect acting
• Pilocarpine:
• produces miosis (contraction of pupil)
• decreases IOP
• when used to produce mitosis; onset of action 10-30 minutes, duration 4-8 hours
• when used to reduce IOP: onset of action unknown, peak time of 75 minutes, duration of 4-14 hours
• ocusert should be refrigerated
• Beta Blockers:
• first line treatment in glaucoma
• decrease the production of aqueous humor
• prostaglandin analogues are as effective as beta blockers
• Carbonic Anhydrase Inhibitors
• interfere with production of carbonic acid
• decreases aqueous humor formation and lowers IOP
• used for long term treatment of open angle glaucoma
• recommended only when pilocarpine, beta blockers, epi, and cholinesterase inhibitors have been ineffective
• Osmotics:
• used in emergent treatment of acute closed-angle glaucoma 
• rapidly reduces IOP
• Mydriatics:
• dilate the pupils
• Cycloplegics:
• paralyze muscles of accommodation

Macular Degeneration:

• macula is the part of the eye responsible for sharp central vision; damage to the macula blurs central vision in the affected eye; leads to blind spot in center of vision
• "Wet"- progresses rapidly
• "Dry"- progresses slowly, more prominent (85-90%)

Sensory Impairment

• A shadow spreading over one eye's vision is a sign of retinal detachment which is an emergency
• A black blurry hole in the center of one's vision would be a sign of macular degeneration which is a chronic condition and not an emergency
• Decreased peripheral vision is a sign of glaucoma
• Words looking blurry is a sign of normal aging

Acute Angle Closure Glaucoma

• pain and halo vision
• obstruction to aqueous humor outflow causes an increase in intraocular pressure which is manifested by pain and conjunctival hyperemia
• conjunctival hyperemia: redness of the conjunctiva
• treat acute angle closure glaucoma as medical emergency and administer medications as prescribed to lower IOP

Retinal Detachment:

• floaters or black spots (bleeding) and flashing lights
• detachment or separation of retina from epithelium
• partial detachment becomes complete if untreated
• when detachment becomes complete blindness occurs
• sense of curtain being drawn over eye
• loss of portion of visual field; painless loss of central of peripheral vision

Retinal Detachment Interventions:

• provide bed rest
• cover both eyes with patches to prevent further detachment
• speak to client before approaching
• protect client from injury
• avoid jerky head movements
• minimize eye stress
• prepare for surgery