HESI MEDICAL SURGERY STUDY GUIDE
Gina Colao
Advanced Medical-Surgical HESI Study
Guide
Work Cited: All information was found in HESI book & Junior
Med Surg book
The difference between open & closed angle
glaucoma
Chronic open-angle glaucoma is also known as simple
adult primary glaucoma and as primary open-angle
glaucoma.
Description: Condition characterized by increased
intraocular pressure (IOP)
A. Glaucoma involves gradual, painless vision loss
B. Glaucoma may lead to blindness if untreated
C. Glaucoma is the second leading cause of blindness in
the U.S.
D. There is an increased incidence in glaucoma in older
adult populations
E. Glaucoma usually occurs bilaterally in those who have a
family history of the condition
F. Aqueous fluid is inadequately drained from the eye
G. It is generally asymptomatic, especially in the early
stages
H. It tends to be diagnosed during routine visual
examinations
I. It cannot be cured, but can be treated with success
pharmacologically and surgically
HESI HINT*
Glaucoma is often painless and symptom-free. It is
usually picked up as part of a regular eye
examination.
Nursing Assessment
A. Early Signs
1. Increase in IOP >22 mm Hg
2. Decreased accommodation or ability to focus
, B. Late signs include:
1. Loss of peripheral vision
2. Seeing halos around lights
3. Decreased visual acuity not correctable with
glasses
4. Headache or eye pain that may be so severe as
to cause nausea and vomiting (Acute closed-
angle glaucoma)
C. Risk factors include the following:
1. Family hx of glaucoma
2. Family hx of diabetes
3. Medication use and interaction of medications
(e.g. glaucoma is a side effect of antihistamines,
anticholinergics)
Primary Open-Angle Glaucoma: is the most common type of
glaucoma. The outflow of aqueous humor is decreased in the
trecbecular meshwork (area of tissue in the eye located around the
base of the cornea, near the ciliary body, and is responsible for draining
the aqueous humor from the eye via the anterior chamber). The
drainage channels become clogged like a clogged kitchen
sink. Damage to the optic nerve can then result.
Primary Closed-Angle Glaucoma: is due to a reduction in
outflow of aqueous humor that results from angle closure.
Usually this is caused by the lens bulging forward as a result
of the aging process. Angle closure may also occur as a
result of pupil dilation in the patient with anatomically
narrow angles. It may also occur due to drug-induced
myadriasis (dilation of pupil), emotional excitement, or
darkness.
HESI HINT*
Eye drops are used to cause pupil constriction because
movement of the muscles to constrict the pupil also allows
aqueous humor to flow out, thereby decreasing the pressure
in the eye. Pilocarpine is commonly used. Caution the client
that vision may be blurred for 1-2 hours after administration
of Pilocarpine and that adaptation to dark environments is
difficult because of pupillary constriction (the desired effect
of the drug)
, HESI HINT*
There is an increased incidence of glaucoma in older adult
populations. Older clients are prone to problems associated
with constipation. Therefore, the nurse should assess these
clients for constipation and postoperative complications
associated with constipation and should implement a plan of
care directed at prevention of, and if necessary, treatment
for constipation.
…. Constipation and straining at stool causes an increase in
intraocular pressure (IOP)!
Syndrome of Inappropriate Antidiuretic
Hormone(SIADH)
Rare; usually the result of an underlying condition such as
Diabetes Insipidus
Results from abnormally high production/release of ADH
Characterized by hyponatremia and high urine specific
gravity aka concentrated urine (greater 1.030).
BE ALERT FOR LOW URINE OUTPUT WITH A HIGH SPECIFIC
GRAVITY*** KEY ASSESSMENT
What patient exhibits: Decreased urine output, edema,
weight gain,
thirst, dyspnea on exertion, fatigue, nausea, weakness,
weight gain, headache confusion, irritablilty, coma and
seizures
Treatment: fluid restriction 800-1000 mL/day; decreased Na
diet (salty foods will cause pt to be thirsty so look out!)
Weigh patient daily to monitor changes in fluid balance, and
the use of ice chips and sugarless gum help decrease thirst
Hyperthyroidism(Graves Disease, Goiter)
Description: Excessive activity of the thyroid gland, resulting
in an elevated level of circulating thyroid hormones. Possibly
long-term or lifelong treatment.
A. Hyperthyroidism can result from a primary disease
state; from the use of replacement hormone therapy; or
from excess thyroid stimulating hormone (TSH) being
produced by an anterior pituitary tumor.
Gina Colao
Advanced Medical-Surgical HESI Study
Guide
Work Cited: All information was found in HESI book & Junior
Med Surg book
The difference between open & closed angle
glaucoma
Chronic open-angle glaucoma is also known as simple
adult primary glaucoma and as primary open-angle
glaucoma.
Description: Condition characterized by increased
intraocular pressure (IOP)
A. Glaucoma involves gradual, painless vision loss
B. Glaucoma may lead to blindness if untreated
C. Glaucoma is the second leading cause of blindness in
the U.S.
D. There is an increased incidence in glaucoma in older
adult populations
E. Glaucoma usually occurs bilaterally in those who have a
family history of the condition
F. Aqueous fluid is inadequately drained from the eye
G. It is generally asymptomatic, especially in the early
stages
H. It tends to be diagnosed during routine visual
examinations
I. It cannot be cured, but can be treated with success
pharmacologically and surgically
HESI HINT*
Glaucoma is often painless and symptom-free. It is
usually picked up as part of a regular eye
examination.
Nursing Assessment
A. Early Signs
1. Increase in IOP >22 mm Hg
2. Decreased accommodation or ability to focus
, B. Late signs include:
1. Loss of peripheral vision
2. Seeing halos around lights
3. Decreased visual acuity not correctable with
glasses
4. Headache or eye pain that may be so severe as
to cause nausea and vomiting (Acute closed-
angle glaucoma)
C. Risk factors include the following:
1. Family hx of glaucoma
2. Family hx of diabetes
3. Medication use and interaction of medications
(e.g. glaucoma is a side effect of antihistamines,
anticholinergics)
Primary Open-Angle Glaucoma: is the most common type of
glaucoma. The outflow of aqueous humor is decreased in the
trecbecular meshwork (area of tissue in the eye located around the
base of the cornea, near the ciliary body, and is responsible for draining
the aqueous humor from the eye via the anterior chamber). The
drainage channels become clogged like a clogged kitchen
sink. Damage to the optic nerve can then result.
Primary Closed-Angle Glaucoma: is due to a reduction in
outflow of aqueous humor that results from angle closure.
Usually this is caused by the lens bulging forward as a result
of the aging process. Angle closure may also occur as a
result of pupil dilation in the patient with anatomically
narrow angles. It may also occur due to drug-induced
myadriasis (dilation of pupil), emotional excitement, or
darkness.
HESI HINT*
Eye drops are used to cause pupil constriction because
movement of the muscles to constrict the pupil also allows
aqueous humor to flow out, thereby decreasing the pressure
in the eye. Pilocarpine is commonly used. Caution the client
that vision may be blurred for 1-2 hours after administration
of Pilocarpine and that adaptation to dark environments is
difficult because of pupillary constriction (the desired effect
of the drug)
, HESI HINT*
There is an increased incidence of glaucoma in older adult
populations. Older clients are prone to problems associated
with constipation. Therefore, the nurse should assess these
clients for constipation and postoperative complications
associated with constipation and should implement a plan of
care directed at prevention of, and if necessary, treatment
for constipation.
…. Constipation and straining at stool causes an increase in
intraocular pressure (IOP)!
Syndrome of Inappropriate Antidiuretic
Hormone(SIADH)
Rare; usually the result of an underlying condition such as
Diabetes Insipidus
Results from abnormally high production/release of ADH
Characterized by hyponatremia and high urine specific
gravity aka concentrated urine (greater 1.030).
BE ALERT FOR LOW URINE OUTPUT WITH A HIGH SPECIFIC
GRAVITY*** KEY ASSESSMENT
What patient exhibits: Decreased urine output, edema,
weight gain,
thirst, dyspnea on exertion, fatigue, nausea, weakness,
weight gain, headache confusion, irritablilty, coma and
seizures
Treatment: fluid restriction 800-1000 mL/day; decreased Na
diet (salty foods will cause pt to be thirsty so look out!)
Weigh patient daily to monitor changes in fluid balance, and
the use of ice chips and sugarless gum help decrease thirst
Hyperthyroidism(Graves Disease, Goiter)
Description: Excessive activity of the thyroid gland, resulting
in an elevated level of circulating thyroid hormones. Possibly
long-term or lifelong treatment.
A. Hyperthyroidism can result from a primary disease
state; from the use of replacement hormone therapy; or
from excess thyroid stimulating hormone (TSH) being
produced by an anterior pituitary tumor.
