308 Adult Flashcards
X-linked recessive disorders (eg, hemophilia, Duchenne muscular dystrophy)
most often affect male offspring
Cystic fibrosis
autosomal recessive inheritance pattern = offspring must receive two abnormal genes (one from each parent)
thiamine intake for alcohol use
Poor thiamine intake and/or absorption can lead to Wernicke encephalopathy, a serious complication that manifests as altered mental status, oculomotor dysfunction, and ataxia.
Spinal immobilization
NSAIDs:
N - Neurological examination. Focal deficits include numbness and decreased strength.
S - Significant traumatic mechanism of injury
A - Alertness. The client may be disoriented or have an altered level of consciousness
I - Intoxication. The client could have impaired decision-making ability or lack awareness of pain
D - Distracting injury. Another significant injury could distract the client from spinal pain.
S - Spinal examination. Point tenderness over the spine or neck pain on movement (if there is no midline tenderness) may be present
lumbar puncture
sitting or left side-lying position with the knees drawn up (ie, fetal position)
insertion of a needle into the vertebral space to collect cerebrospinal fluid (CSF) for analysis of color, content, and pressure
L3-4 or L4-5
The client may experience pain radiating down the leg during the procedure, but it should be temporary.
Valsalva maneuver
holding the breath while bearing down and contracting the abdominal muscles (eg, straining during defecation)
simulates the vasovagal response, causing
-bradycardia
-decreased CO
-hypotension
-provokes dysrhythmias.
facilitates voiding, equalizes ear pressure, treats supraventricular tachycardia, and is an adjunctive technique to avoid an air embolism when a line (eg, central venous access device) or drain is removed
contraindicated:
Clients with glaucoma or recent eye surgery (eg, cataract surgery) because straining increases intraocular pressure
Clients unable to hemodynamically compensate due to certain heart conditions (eg, heart failure, myocardial infarction) When the client relaxes, blood flow rapidly returns to the heart. If the heart is unable to compensate for the blood flow increase, fatal complications can occur.
Clients recently diagnosed with increased intracranial pressure, stroke, or a head injury. Straining increases intraabdominal and intrathoracic pressure, which raises the intracranial pressure.
Clients with portal hypertension related to cirrhosis. Straining should be avoided due to the risk of variceal bleeding induced by increased pressure
Coup-contrecoup head injuries
common in motor vehicle accidents and shaken baby syndrome
Damage to the occipital lobe =visual disturbances.
the frontal lobe - primary impact (coup). =Executive function, memory, speech (Broca area), and voluntary movement are controlled by the frontal lobe
ischemic stroke +
Permissive hypertension
maintaining a compensatory elevation in blood pressure (BP), typically for the first 24 hours following ischemic stroke, to promote cerebral perfusion
maintains a systolic BP ≥170 mm Hg
Permissive hypertension usually autocorrects and does not require treatment unless extreme hypertension occurs (eg, systolic BP >220 mm Hg).
Neurogenic shock
Overwhelming parasympathetic stimulation:
Bradycardia
Hypotension
Impaired temperature regulation
Decreased CO
Neurogenic shock is a type of distributive shock that occurs most commonly after a cervical or high thoracic spinal cord injury. The injury causes a loss of sympathetic stimulation, allowing the parasympathetic nervous system to take over.
Bell palsy
peripheral, unilateral facial paralysis characterized by inflammation of the facial nerve (cranial nerve VII) in the absence of a stroke or another causative agent/disease
Inability to smile symmetrically
Loss of forehead and brow movements
Decreased lacrimation (ie, tear production)
Inability to close the affected eye completely
Loss of nasolabial folds and drooping of the lower lip
Amyotrophic lateral sclerosis (ALS, Lou Gehrig disease)
progressive degeneration of motor neurons in the brain and spinal cord
S/s:
fatigue
progressive muscle weakness,
twitching and muscle spasms,
difficulty swallowing
difficulty speaking
respiratory failure
Most clients survive only 3-5 years after the diagnosis as there is no cure.
symptom management:
Respiratory support with noninvasive positive pressure (eg, bilevel positive airway pressure [BiPAP]) or invasive mechanical ventilation (eg, via tracheostomy)
Feeding tube for enteral nutrition
Medications to decrease symptoms (eg, spasms, uncontrolled secretions, dyspnea)
Mobility assistive devices (eg, walker, wheelchair)
Communication assistive devices (eg, alphabet boards, specialized computers)
arteriovenous malformation
a tangle of veins and arteries that is believed to form during embryonic development
The tangled vessels do not have a capillary bed, causing them to become weak and dilated
AVMs are usually found in the brain and can cause seizures, headaches, and neurologic deficits
blood pressure control is crucial
high risk for having an intracranial bleed
Any neurologic changes, sudden severe headache, nausea, and vomiting should be evaluated immediately as these are usually the first symptoms of a hemorrhage
Guillain-Barré syndrome
Aspiration pneumonia
Respiratory failure
Cardiac arrhythmias
Pressure injuries
Venous thromboembolism
Ileus
follows a respiratory or gastrointestinal infection that triggers an immune response => peripheral nerve inflammation.
S/s:
ascending, symmetric muscle paralysis and areflexia (ie, absence of reflexes) that can eventually progress to involve the thorax and cranial nerves
monitor for the following findings:
Blood pressure variability: Autonomic dysfunction is common in GBS and can cause blood pressure/heart rate instability, leading to hypertension, hypotension, or dysrhythmias
Decreased respiratory rate and depth: These occur when ascending muscle weakness progresses to the thorax. The nurse should monitor for signs of respiratory distress (eg, decreased capillary oxygen saturation, hypoventilation, breathlessness while speaking, labored breathing) and be prepared for intubation if the client is unable to independently ventilate due to thoracic muscle paralysis
Difficulty swallowing: Paralysis and weakness of the cranial nerves make eating and swallowing difficult, increasing the risk for aspiration pneumonia. In addition, difficulty swallowing may be a warning sign of impending respiratory compromise.
Urinary retention: This occurs secondary to autonomic dysfunction. Clients with GBS may need temporary intermittent urinary catheterization
Motor function of the eyes
cranial nerves III, IV, and VI.
Oculomotor (III)
Trochlear (IV)
Abducens (VI)
3,4,6
Trigeminal neuralgia
excruciating, unilateral facial pain along the distribution of the trigeminal nerve that is often triggered by touch, talking, or hot/cold intake.
The condition is not life-threatening.
Epidural hematoma
arterial bleeding
initial loss of consciousness, then a period of lucidity followed by a rapid decline in neurologic function
Bell palsy
idiopathic, unilateral facial paralysis caused by inflammation of the facial nerve.
Treatment includes corticosteroids and protection of the eye (which may not close tightly).
Bell palsy often resolves after several months as inflammation subsides.
Aspiration pneumonia
Thicken liquids (eg, to nectar or honey consistency) for clients with dysphagia
Ensure that the client is fully awake before eating. The nurse should time the administration of sedating medications (eg, opioids, benzodiazepines) to avoid sedation during meals
Elevate the head of the bed to 90 degrees during and for 30 minutes after meals, and never place the head of the bed lower than 30 degrees
Encourage clients to facilitate swallowing by flexing the neck (chin to chest)
Administer prescribed antiemetics (eg, ondansetron) as needed to prevent vomiting.
Monitor for coughing, gagging, and pocketing food.
cerebellum
coordination of voluntary movements and maintenance of balance and posture.
Balance is assessed with heel-to-toe gait testing.
Coordination is assessed with finger tapping, rapid alternating movements, finger-to-nose testing, and heel-to-shin testing.
Epilepsy
chronic seizure activity
lifelong anticonvulsant medication
Phenytoin (Dilantin), a hydantoin anticonvulsant, may decrease the effectiveness of some medications (eg, oral contraceptives, warfarin) due to stimulation of hepatic metabolism
discuss pregnancy plans with their health care provider, as phenytoin can cause fetal abnormalities (eg, cleft palate, heart malformations, bleeding disorders)
avoiding seizure triggers:
excessive alcohol intake, sleep deprivation, and stress
Anticonvulsants should not be stopped abruptly
practicing good oral hygiene as gingival hyperplasia is a potential complication
Delirium
an acute, usually reversible change in mentation due to an underlying cause (eg, lack of sleep, hypoxia, medications)
S/s
may fluctuate between hyperactivity (eg, paranoia, aggression, hostility) and hypoactivity (eg, decreased level of consciousness).
Difficulty sustaining attention despite continued efforts to reorient and redirect the client
Disorganized speech accompanied by impaired memory and executive function
Fluctuating levels of consciousness (eg, acute change from drowsy to combative)
Precipitating factors include:
Hypoxia
Acute infection (eg, urinary tract infection)
Fever
Electrolyte imbalances (eg, hyponatremia)
Sleep deprivation
Dehydration or malnutrition
Metabolic disorders (eg, hypoglycemia)
Medications (eg, opioids, benzodiazepines)
prevent wandering in
Alzheimer disease
install a door sensor to alert family members
seizure
uncontrolled electrical discharge in the brain
4 phases:
- prodromal (pre-seizure warning signs),
- aural (preseizure sensory changes)
- ictal (active seizure activity)
- postictal (postseizure). During the postictal phase, the client may experience confusion and/or a headache.
autonomic dysreflexia
T6 and up
uncompensated sympathetic nervous system stimulation.
S/s:
hypertension (up to 300 mm Hg systolic),
throbbing headache,
diaphoresis above the level of injury, bradycardia (30-40/min),
piloerection (“goose bumps”), flushing, and nausea
HOB elevated 45 degrees or high Fowler’s to lower blood pressure
bladder irritation due to distention.
The client needs to be catheterized or the possibility of a kink in the existing catheter must be assessed
Bowel impaction can also be a cause; a digital rectal examination should be performed.
Constrictive clothing should be removed to decrease skin stimulation
Multiple sclerosis (MS)
Corticosteroids (eg, methylprednisolone)
a chronic autoimmune disorder that typically presents in young adults, especially women of childbearing age
autoimmune destruction of the myelin-sheath in the central nervous system (ie, brain, spinal cord)
causes abnormal and slowed conduction through the nerves
MS causes motor and sensory loss below the level of the lesion.
S/s:
muscle weakness
spastic paralysis with hyperreflexia, and paresthesia (eg, pins-and-needles sensation).
the optic nerve is an extension of brain tissue=demyelination results in eye pain and visual disturbances (eg, blurry vision).
discharging a client with a head injury/concussion
don’t have to stay awake
ensuring that a responsible adult will check on the client as the level of consciousness can change
abstain from alcohol
check before taking medications that can affect level of consciousness (eg, muscle relaxants, opioids)
avoid driving or operating heavy machinery
return to the emergency department or notify the primary care provider if any of the following signs/symptoms are present in the next 2-3 days:
Change in level of consciousness (eg, increased drowsiness, difficulty arousing, confusion)
Worsening headache or stiff neck, especially if unrelieved by over-the-counter analgesics
Visual changes (eg, blurring)
Motor problems (eg, difficulty walking, slurred speech)
Sensory disturbances
Seizures
Nausea/vomiting or bradycardia (indicates IICP)
ruptured cerebral aneurysm
usually asymptomatic unless they rupture; they are often called “silent killers”
S/s:
abrupt onset of “the worst headache of my life”
changes in or loss of consciousness
neurologic deficits
diplopia
seizures
vomiting
stiff neck
intracranial hemorrhage
During and after tissue plasminogen activator (tPA) administration
Decreased level of consciousness (ie, client is now disoriented)
Agitation and confusion
Projectile (forceful) vomiting
Severe hypertension—SBP >180 and/or DBP >120
If ICH is suspected, a repeat CT scan of the head is the priority action to identify bleeding.
Once ICH is confirmed, prompt treatment (eg, reverse anticoagulation [eg, tranexamic acid], blood pressure management [eg, nicardipine], surgery) is required to prevent life-threatening complications
Thrombolytics (ie, tissue plasminogen activators [tPA]) (eg, alteplase, reteplase)
used to lyse (ie, break apart) thrombi (eg, clots)
Ask the client’s caretaker about history of recent surgery or trauma: Recent (ie, within 2 weeks) major surgery is an exclusion to thrombolytic therapy because tPA dissolves all clots in the body and may therefore disrupt the surgical site and cause bleeding
Maintain BP ≤185/110: BP >185/110 mm Hg is an exclusion to thrombolytic therapy due to the risk for intracerebral hemorrhage
Review the client’s current home medication list:
for any additional anticoagulants
Verify the exact time the stroke symptoms started: Thrombolytics are time sensitive and must be administered within 3 to 4.5 hours from onset of symptoms
ischemic stroke
12-lead ECG
to detect atrial fibrillation
fall risk precautions
frequent neurological assessments
Ensuring tissue plasminogen activator (tPA) is available
Applying sequential compression devices (SCDs) to bilateral lower extremities
NPO
acute focal neurological symptoms
obtain a capillary blood glucose level to rule out hypoglycemia
prepare the client for CT scan of the head to determine if the client is experiencing a stroke and the type and location of the stroke
use a standardized stroke assessment tool to determine the likelihood, location, and severity of an acute stroke.
Buck traction
skin traction to immobilize a fractured hip, maintain proper alignment, and reduce pain and muscle spasms by applying a continuous pulling force until the client has surgery (eg, hip arthroplasty).
A traction boot is applied to the affected extremity. The weight (5-10 lb [2.26-4.5 kg]), connected by a rope passing through a pulley, is attached to the boot.
Weights should be free-hanging at all times and should never touch the floor or be placed on the bed
A fracture pan, which is smaller than a bedpan, should be provided for elimination needs to minimize client movement and provide comfort.
maintain the foot in a neutral position
hip fractures
external rotation
Ecchymosis and tenderness over the thigh and hip
Groin and hip pain with weight bearing
Muscle spasm in the injured area – occurs as the muscles surrounding the fracture contract to try to protect and stabilize the injured area
Shortening of the affected extremity – occurs because the fracture can reduce the length of the bone and the muscles above the fracture line pull the extremity upward
Abduction or adduction of the affected extremity depending on location and mechanism of injury.
Lumbosacral disc herniation
when an intervertebral disc ruptures and herniates (bulges), most often between L4-L5
after lifting heavy weights or using improper body mechanics
S/s:
low back pain
paresthesia that radiates to the lower extremities
different lower extremity reflexes (eg, Achilles) become diminished
a positive straight-leg raising test due to nerve root compression
lumbar strain - pain that does not radiate
Cauda equina syndrome
a medical emergency marked by compression of multiple spinal nerve roots of the cauda equina (ie, tail-like extension of nerve roots from termination of the spinal cord
caused by central lumbar disc herniation at L4-S1 (ie, lumbar and sacral)
requires surgical decompression within 24-48 hours to prevent irreversible neurological damage
S/s:
Motor deficits in the lower extremities (eg, flaccid paralysis, absent/diminished reflexes)
Patchy sensory loss in corresponding dermatomes
Autonomic (eg, bowel, bladder, sexual) dysfunction
Joint dislocations may become orthopedic emergencies
because articular bone may compress surrounding vasculature, causing limb-threatening distal ischemia
Fat embolism syndrome (FES)
hallmark: pinpoint red rash on chest
rare, life-threatening complication related to bone fractures, typically of the pelvis or long bones
no specific treatment
at globules travel through the bloodstream and obstruct small blood vessels, causing impaired circulation and ischemia. The lungs, brain, and skin are most often affected, leading to acute respiratory distress and neurologic impairment.
S/s:
Respiratory distress syndrome (eg, dyspnea, tachycardia, sudden and worsening chest pain, hypoxemia, restlessness, anxiety)
Altered mental status (eg, confusion, memory loss)
Petechial hemorrhages in the arms, chest, and/or neck
halo external fixation device
stabilizes a cervical or high thoracic fracture when there is insignificant damage to the ligaments or spinal cord
Cleaning pin sites with sterile solution (eg, chlorhexidine, water) to prevent infection
Keeping the vest liner clean and dry (eg, changing weekly or when soiled, using a cool blow-dryer to dry) to protect the skin
Placing foam inserts under pressure points to prevent pressure injury
Placing a small pillow under the client’s head when supine to reduce pressure on the device
Keeping the correct-sized wrench available at all times in case of emergency
do not grab the device while log rolling
An elderly client with osteoporosis falls onto an out-stretched hand and injures the wrist. The client has severe wrist edema, deformity, and pain rated a 10 on a pain scale of 0-10. What should be the nurse’s first action?
priority nursing action:
neurovascular assessment (eg, pulse, temperature, color, capillary refill, sensation, movement
Administering analgesia to promote comfort
Applying an ice pack to the wrist to help reduce edema and inflammation
Elevating the extremity on a pillow above heart level to reduce edema
Instructing the client to move the fingers to reduce edema, increase venous return, and help improve range of motion.
Total hip arthroplasty
at risk for hip dislocation until the surrounding soft tissues heal
Applying sequential compression devices bilaterally to the lower extremities to promote blood flow and reduce the risk for venous thromboembolism related to immobility
Assessing the client’s pain level and administering pain medications as prescribed.
Monitoring the surgical dressing for drainage, which may indicate hemorrhage
Placing an abductor pillow between the client’s legs to maintain the hip in a neutral position while in bed because adduction (ie, moving the leg medially) can cause dislocation
knee arthroplasty
client should be fully weight bearing by discharge
Malignant hyperthermia
Prompt administration of IV dantrolene is critical to survival.
life-threatening condition triggered by certain medications used for general anesthesia (eg, succinylcholine).
S/s
tachypnea, tachycardia, generalized muscle rigidity, and hyperthermia
The triggering agent causes excessive calcium release from the muscles, leading to sustained muscle contraction.
above-the-knee amputation
do not elevate leg after the first 24 hours because this can cause flexion contractures.
Instead, the client should wear a figure eight compression bandage at all times to control edema
Hip flexion contractures can also be avoided by placing the client in the prone position with the hip in extension for 30 minutes 3 or 4 times daily.
(Option 1) A plaster cast may take up to 72 hours to dry following application. Exposing the cast to circulating air promotes even drying and may speed the drying process.
Ankylosing spondylitis
inflammatory disease affecting the spine
S/s
stiffness and fusion of the axial joints (eg, spine, sacroiliac), leading to restricted spinal mobility. Low back pain and morning stiffness that improve with activity are the classic findings.
Involvement of the thoracic spine (costovertebral) and costosternal junctions can limit chest wall expansion, leading to hypoventilation.
Promote extension of the spine with proper posture, daily stretching, and spine-stretching exercises (eg, swimming, racquet sports)
Stop smoking and practice breathing exercises to increase chest expansion and reduce lung complications
Manage pain with moist heat and NSAIDs.
Take immunosuppressant and anti-inflammatory medications as prescribed to reduce inflammation and increase mobility.
rest during flare-ups.
sleep on their backs on a firm mattress to prevent spinal flexion and the resulting deformity.
Ibuprofen and other NSAIDs should be taken with a meal or snack to avoid gastric upset.
Rhabdomyolysis
occurs when muscle fibers are released into the blood
causes:
an intense muscle injury from exercise, heat stroke, or physical trauma
S/s:
dark, oftentimes bloody urine, oliguria, and fatigue.
Acute renal failure can occur when elevated myoglobin (protein found in muscle tissue) levels overwhelm the kidneys’ filtration ability
priority: prevent kidney damage using rapid IV fluid resuscitation to flush the damaging myoglobin pigment from the body.
7 P’s of Compartment syndrome
Paresthesia
(early sign)
Tingling, numbness, burning
Pain
Out of proportion to injury, unrelieved by medication
Pressure
Taut skin, cast fits too tightly
Pallor
Pale skin tone, decreased color, white, gray
Pulselessness
(uncommon)
Possibly weakened or lost
Poikilothermy
Cool skin temperature, matches room temperature
Paralysis
(late sign)
Weakness, loss of motor activity
Casts
never insert objects inside the cast to scratch
Report foul odors or hot areas (hot spots) in the cast, which may indicate infection
Avoid getting the cast wet, which may damage the cast and cause skin irritation/infection
Elevate the affected extremity above heart level for the first 48 hours to reduce edema
Regularly perform isometric and range of motion exercises to prevent muscle atrophy.
Directing air inside the cast with a hair dryer on the cool setting may help relieve itching.
contact the health care provider about symptoms of impaired circulation in the affected extremity, including numbness or tingling, pallor, coolness, loss of pulse distal to the cast, or pain that is unrelieved by ice, elevation, and pain medication. Swelling within the cast may result in compartment syndrome, a condition that involves limb-threatening tissue ischemia due to compression of blood vessels and nerves within the extremity’s internal compartments.
fractured mandible
If wired shut and is choking on spit= suction along gum line
if ineffective and the client develops respiratory distress, cutting the wires may be necessary.
A tracheostomy or endotracheal tray should be kept readily available in case the client’s airway becomes obstructed and intubation is necessary.
external fixator
device used to stabilize broken bones
metal pins are placed through the tissue into the bone and connect to a frame outside the skin.
Monitor:
neurovascular compromise
pin site infection,
can lead to osteomyelitis
Assess pin sites for new, increased, and/or purulent drainage and check the skin surrounding the pins for erythema, warmth, pain, or breakdown
Assess for signs of compartment syndrome
decreased pulses, coolness, pain, numbness
pin site care with a sterile cleaning solution (eg, chlorhexidine, sterile normal saline) and gauze
Monitoring pins and device for loosening and reporting to the health care provider (HCP) if they are loose
promote early mobilization the day after sx
pelvic fracture from car crash
internal hemorrhage
abdominal distension, vital signs, hematocrit, hemoglobin
paralytic ileus
absent bowel sounds
neurovascular deficits
extremity circulation, sensation, movement
abdominal and genitourinary organ injuries
hematuria, urine output <0.5 mL/kg/hr
Bisphosphonates (eg, alendronate)
inhibit bone resorption by osteoclasts
reducing the risk for osteoporosis-related bone fractures
teaching:
full glass of water (8 oz [240 mL])
remain upright for 30 to 60 minutes
don’t take it with Calcium
empty stomach
Compartment syndrome
requires emergency evaluation by a health care provider -> limb loss
serious postoperative complication
caused by decreased blood flow to the tissue distal to the injury
restrictive dressings, splints, or casts
bleeding, inflammation, and edema
Earliest symptoms
pain or numbness that is unrelieved by medication.
diminished/absent pulses
pallor
coolness
swelling
decreased movement
cyanosis
the extremity should be positioned at the level of the heart.
ABCDE
Asymmetry
Border irregularity (eg, edges are notched or irregular)
Color changes and variation (eg, different brown or black pigmentation)
Diameter of 6 mm or larger (about the size of a pencil eraser)
Evolving (eg, appearance is changing in shape, size, color)
Evisceration (ie, protrusion of underlying organs through a surgical incision
stay with the client. Have a staff member notify the surgeon immediately
tell pt not to cough
Cover the area with sterile, saline-moistened gauze to protect the exposed organs and reduce the risk for infection
Obtain vital signs to detect signs of potential shock (eg, hypotension, tachycardia)
low Fowler position (ie, head of bed at 15-20 degrees) with the knees slightly flexed to decrease intraabdominal pressure and avoid further evisceration
Document interventions and the appearance of the wound and eviscerated organ (eg, color, drainage). If circulation is interrupted, the protruding organs can become ischemic (dusky) or necrotic (black).
Tinea corporis (ringworm)
fungal infection
person-person
scaly, pruritic patch that is circular
highly contagious
treated with topical antifungals (eg, tolnaftate, haloprogin, miconazole, clotrimazole).
Parkland formula is an IV fluid resuscitation
4 mL×body weight (kg)×% TBSA=infusion volume (mL)
Nursing management of an unstageable pressure injury
Cleanse wound with normal saline
Cover wound with a hydrophilic (ie, “water-loving”) dressing that absorbs moisture
Frequently reposition pt and off-load the affected area
Immediately after exposure to poison ivy
thoroughly wash the area to remove the oily resin
(which is responsible for causing the rash that follows in 12-48 hours)
solution of choice for fluid resuscitation of a burned client
Lactated Ringer’s
stevens johnson syndrome
immune-mediated, acute skin reaction triggered by certain classes of medications ->
Initial manifestations are nonspecific and flu-like (eg, fever, fatigue)
burn-like rash and blistered lesions that often involve the mucous membranes
Epidermal shedding (ie, skin detachment) occurs on the face, trunk, and palms, resulting in painful areas of exposed dermis
common med triggers
Allopurinol
Antibiotics (eg, sulfonamides)
Anticonvulsants (eg, carbamazepine, lamotrigine, phenytoin)
NSAIDs
Sulfasalazine
Wound care for burn injuries
Heat the client’s room to 85 F (29.4 C)
sterile
premedicate
allergies
Herpes zoster (shingles)
causes transient pain due to hemorrhagic inflammation of the sensory nerve.
skin lesions resolve and the pain typically fades; however, persistent pain (ie, >3 months) indicates postherpetic neuralgia
stabbing, tingling, or burning sensation. Pain is triggered or worsened by light touch (eg, washing the affected area)
Histoplasmosis
opportunistic fungal infection that most commonly occurs in clients with compromised immunity
from inhaling Histoplasma capsulatum spores that are typically found in soil that contains bird or bat droppings.
TB
classic S/s
Low-grade fever
Night sweats
Anorexia and weight loss
Fatigue
Additional symptoms depend on the location of the infection.
Pulmonary tuberculosis typically includes:
Cough
Purulent or blood-tinged sputum
Shortness of breath
Back pain indicates spinal TB.
Dysuria is a symptom of extrapulmonary genitourinary TB.
Jaundice can be present in disseminated TB with liver involvement. It can also be a side effect associated with drugs used to treat pulmonary TB (eg, isoniazid).
Cystitis (a UTI)
infection of the lower urinary tract and involves inflammation of the bladder mucosa, leading to hyperemia, tissue hemorrhage, and pus formation
S/s:
-burning with urination (dysuria),
-urinary frequency and urgency, ———-hematuria,
-suprapubic discomfort
if the infection extends to the kidneys (pyelonephritis), clients become seriously ill with nausea, vomiting, fever with chills, and flank pain.
accurately diagnose active TB
AFB sputum culture is the standard
three sputum cultures should be collected at 8- to 24-hour intervals
least one of the sputum cultures collected in the early morning.
Oral candidiasis
an overgrowth of Candida albicans (ie, yeast), a component of normal flora (eg, skin, mucous membranes)
S/s
white patches on the oral mucosa, palate, and tongue (ie, “thrush”)
Causes:
local microbial flora is disrupted (eg, prolonged antibiotic therapy)
immune response is impaired (eg, HIV)
Inhaled corticosteroids (eg, budesonide, fluticasone),
Jarisch-Herxheimer reaction
systemic inflammatory response that occurs within hours of initiating antibiotic therapy for certain infections (eg, syphilis, Lyme disease)
Rapid lysis of large amounts of bacteria causes the releases of intracellular components into the bloodstream, which triggers a strong immunological response.
S/s:
fever, myalgia, rigors, sweating, hypotension, and aggravation of preexisting rashes (ie, worsened maculopapular rash). Manifestations are usually self-limited and resolve spontaneously within 48 hours.
Scabies
highly contagious skin infestation of the Sarcoptes scabiei mite
direct person-to-person contact
apply the medication from the neck down before going to bed at night
avoiding application near the eyes or mouth
treating all household members,
retreating 1-2 weeks later.
Genital herpes
herpes simplex virus type 2
no cure
S/s
small, painful vesicular lesions on an erythematous (reddened) base
Rheumatic heart disease
mechanical valve
chronic scarring and damage to heart valves caused by recurrent rheumatic fever
Heart valve replacement may be necessary for clients who are not responsive to nonsurgical measures
Notifying the health care provider of any flu-like symptoms
indicate infective endocarditis (IE)
Taking prophylactic antibiotics before invasive dental procedures
bacteria in the bloodstream can increase the risk for IE
Adhering to life-long anticoagulation therapy
vitamin K antagonist (eg, warfarin)
Anaphylactic shock
Call for help (activate emergency management systems) – first action
develop quickly (20-30 minutes
hypotension
laryngeal edema (from inflammation) bronchoconstriction (from release of histamine);-> these can lead to cardiac and respiratory arrest.
Call for help (activate emergency management systems) – first action
Maintain airway and breathing – administer high-flow O2 via non-rebreather mask
Epinephrine, intramuscular – the drug of choice and should be given next. Epinephrine stimulates both alpha- and beta-adrenergic receptors, dilates bronchial smooth muscle (beta 2), and provides vasoconstriction (alpha 1). The IM route is better than the subcutaneous route. The dose should be repeated every 5-15 minutes if there is no response.
Elevate the legs
Volume resuscitation with IV fluids
Bronchodilator (albuterol) to dilate the small airways and reverse bronchoconstriction
Antihistamine (diphenhydramine) to modify the hypersensitivity reaction and relieve pruritus
Corticosteroids (methylprednisolone [Solu-Medrol]) to decrease airway inflammation and swelling associated with the allergic reaction
Tuberculosis (TB) X cortocosteroids
Immunosuppressants such as corticosteroids (eg, prednisone), increase the risk for conversion of latent TB to active TB
Rheumatoid arthritis
inflammation and damage to synovial joints
Progressive fibrosis of joint membranes results in pain, deformity, and stiffness
avoid frequent repetitive movements because overuse of the joints can worsen inflammation and accelerate progression of the condition
to do:
-alternating ice packs and moist heat to reduce inflammation.
- Wearing a splint during periods of inflammation can help to reduce the risk for joint malformation.
Scleroderma
overproduction of collagen that causes tightening and hardening of the skin and connective tissue
Renal crisis - complication
=malignant hypertension due to narrowing of the vessels that provide blood to the kidneys.
Sjögren’s syndrome
a chronic autoimmune disorder in which moisture-producing exocrine glands of the body are attacked by white blood cells.
dry eyes (xerophthalmia) and dry mouth (xerostomia)
Skin - dry skin and rashes
Throat and bronchi - chronic dry cough
Vagina - vaginal dryness and painful intercourse
no cure. tx S/s
avoid OTC decongestants as they cause further dryness to the mouth and nasal mucosa.
eye drops, sugar-free candy or artificial saliva, vaginal lubricants, frequent dental examinations, lukewarm showers with mild soap, and avoiding decongestants.
systemic lupus erythematosus (SLE)
receive inactivated vaccinations
risk for kidney injury (ie, glomerulonephritis) and should receive routine screening of urine for protein, as well as monitoring of serum creatinine
Secondary Raynaud phenomenon can occur
Discharge education for a client after transplant
The client should monitor for transplant rejection (eg, hypertension, edema).
Immunosuppressant (antirejection) medications require lifelong use.
Regular blood specimen collections should be obtained to check medication levels.
Immunosuppressants increase the risk for cancer and infection.
The client should request an inactivated influenza vaccine during influenza season.
Endometrial cancer
risk factors:
Prolonged estrogen exposure without adequate progesterone
obesity
polycystic ovary syndrome
Pregnancy
