A nurse at an ophthalmology clinic is providing teaching to a client who has open-angle glaucoma and a new treatment regimen of timolol and pilocarpine eye drops. Which of the following instructions should the nurse provide?
Administer the medications 5 minutes apart.
Hold pressure on the conjunctival sac for 2 minutes following application of drops.
It is not necessary to remove contact lenses before administering medications.
Administer the medications by touching the tip of the dropper to the sclera of the eye.
The Correct Answer is A
Choice A: Administer the Medications 5 Minutes Apart
Administering the medications 5 minutes apart is crucial when using multiple eye drops. This practice ensures that each medication has enough time to be absorbed without being washed out by the subsequent drop. This is particularly important for medications like timolol and pilocarpine, which are used to manage intraocular pressure in glaucoma.
Choice B: Hold Pressure on the Conjunctival Sac for 2 Minutes Following Application of Drops
Holding pressure on the conjunctival sac (punctal occlusion) for 2 minutes after applying eye drops can help reduce systemic absorption and increase the local effect of the medication. However, this instruction is not as critical as the timing between administering different eye drops.
Choice C: It Is Not Necessary to Remove Contact Lenses Before Administering Medications
This statement is incorrect. Contact lenses should be removed before administering eye drops to prevent contamination and ensure proper absorption of the medication. The lenses can be reinserted after a sufficient amount of time has passed, usually around 15 minutes.
Choice D: Administer the Medications by Touching the Tip of the Dropper to the Sclera of the Eye
This statement is incorrect. The tip of the dropper should never touch the eye or any other surface to avoid contamination. The correct method is to hold the dropper above the eye and squeeze out the prescribed number of drops into the conjunctival sac.
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Correct Answer is ["B","C","D","E"]
Explanation
Choice A: WBC Count
Reason:The white blood cell (WBC) count is not directly related to fall risk. WBC count is an indicator of the immune system’s response to infection or inflammation. In this case, the patient’s WBC count is within the normal range (5,000 to 10,000/mm³) on both days. Therefore, it does not contribute to an increased risk of falls.
Choice B: Parkinson’s disease
Reason:Parkinson’s disease significantly increases the risk of falls due to several factors. Patients with Parkinson’s often experience postural instability, which is the inability to maintain balance when standing or walking. This condition is a cardinal feature of Parkinson’s disease and can lead to frequent falls. Additionally, Parkinson’s patients may experience freezing of gait, where they suddenly cannot move their feet forward despite the intention to walk. This can cause them to fall. Other gait abnormalities, such as festinating gait (short, rapid steps) and dyskinesias (involuntary movements), also contribute to the increased fall risk.
Choice C: Potassium level on day 2
Reason:The patient’s potassium level on day 2 is 3.0 mEq/L, which is below the normal range of 3.5 to 5 mEq/L. Low potassium levels (hypokalemia) can lead to muscle weakness, cramps, and fatigue. These symptoms can impair the patient’s ability to maintain balance and increase the risk of falls. Hypokalemia can also cause abnormal heart rhythms, which can further contribute to the risk of falls.
Choice D: Furosemide
Reason:Furosemide is a diuretic medication used to treat conditions such as heart failure by reducing fluid buildup in the body. However, it can also cause orthostatic hypotension, a condition where blood pressure drops significantly when standing up. This can lead to dizziness, lightheadedness, and an increased risk of falls. Additionally, furosemide can cause electrolyte imbalances, such as low potassium levels, which can further contribute to fall risk.
Choice E: Low blood pressure
Reason: The patient’s blood pressure readings indicate orthostatic hypotension, with a significant drop from 128/56 mm Hg while sitting to 92/40 mm Hg while standing. Orthostatic hypotension is a common condition in patients with Parkinson’s disease and heart failure. It can cause dizziness, lightheadedness, and fainting when changing positions, increasing the risk of falls. The patient’s low blood pressure when standing is a clear indicator of increased fall risk.
Correct Answer is ["A","B","C","D"]
Explanation
Choice A: Add Cream to Soups
Adding cream to soups is an excellent way to increase both calorie and protein intake. Cream is rich in fat and calories, which can help in weight gain and provide the necessary energy for clients undergoing chemotherapy. Additionally, it enhances the flavor and texture of soups, making them more palatable for clients who may have a reduced appetite due to treatment.
Choice B: Dip Meats in Eggs and Bread Crumbs Before Cooking
Dipping meats in eggs and bread crumbs before cooking adds extra calories and protein. Eggs are a good source of high-quality protein, and bread crumbs add additional calories. This method also helps to create a more appealing texture and flavor, which can be beneficial for clients experiencing taste changes due to chemotherapy.
Choice C: Use Milk Instead of Water in Recipes
Using milk instead of water in recipes is another effective strategy to boost calorie and protein intake. Milk contains essential nutrients, including protein, calcium, and vitamins, which are important for maintaining strength and health during chemotherapy. This substitution can be applied to various recipes, such as oatmeal, mashed potatoes, and smoothies.
Choice D: Top Fruits with Yogurt
Topping fruits with yogurt not only increases calorie and protein intake but also adds beneficial probiotics. Yogurt is a good source of protein and calcium, and when combined with fruits, it provides a nutritious and appealing snack or dessert. This combination can help improve appetite and provide essential nutrients needed during chemotherapy.
Choice E: Increase Fluids During Meals
Increasing fluids during meals is not specifically aimed at increasing calorie and protein intake. While staying hydrated is important, excessive fluid intake during meals can sometimes lead to a feeling of fullness, which may reduce overall food intake. It is better to focus on nutrient-dense foods and beverages that provide both hydration and essential nutrients.