(405 sig) things I think are important Flashcards
what to monitor in a fracture pt d/t risk of air or fat embolism
chest pain, tachypnea, cyanosis, apprehension, tachycardia, and hypoxemia
Fat embolism s/s
-resp insuf
-fine crackles or no lung sounds
-hypoxia
-petechial rash
-confusion
-seizure
fat embolism
supportive
ICU for oxygen and fluid
cast care
-no covering to allow for ventilation
-reposition q1-2 hrs until set
-neurovascular distal to cast checks q1 for 24 hrs
- fit 1-2 fingers into the cast
-ice for the first 24-36 hrs
what is performed if pt develops compartment syndrome
emergency fasciotomy
a spinal fusion
add bone graft/synthetic product for stabilization & so the bone isn’t sitting on another bone
post op hip replacement limitations: posterior approach
avoid the following for at least 6 weeks
-extreme internal rotation
-adduction
->90 flexion
-elevate toilet seat
osteoporosis drug therapy: biphosphonates
MOA: inhibit osteoclast resorption
drugs: alendronate & ibandronate
NC: take w/ full glass of water 30 min before food/other meds and then remain upright for 30 mins after
osteoporosis collaborative mgt
prevent
-adequate Ca intake (1000mg per meno & post menu taking estrogen, 1500mg for post meno w/o taking estrogen)
-vit D (800-1000 UI daily; diet + sups)
-load bearing exercise for 30 min 3x/w
-avoid tobacco & excessive alcohol
-corset to prevent vertebral collapse
limiting spread of osteomyelitis is limited by
malnutrition
alcoholism
liver disease
osteoporosis drug therapy: selective estrogen receptor modulators (SERM)
-mimic estrogen effects on bone by reducing bone resorption w/o stimulation breast/uterus
drug: raloxifene
osteomyelitis dx studies
-bone/tissue biopsy
-blood/wound culture +
-inc WBC & ESR
-x rays (but do not show changes until 10 days into infection)
-radionuclide bone scans preferred
-MRI
non drug interventions for OA
-rest/joint protection
-maintain function position prn (orthotic brace)
-avoid prolonged immobilization
-use assistive devices prn
-heat and ice (20 mins on , 20 off)
-weight reduction & aerobic exercise
-yoga, acupuncture, biofeedback
-OTC glucosamine
hydroxychloroquine onset time
2-3 months
medications for RH
-DMARDs -> substantially reduce inflammation of RA, reduce/prevent joint damage, preserve joint structure & function & help maintain activity
-NSAIDS -> immediate relief but do not reduce long term damage & needs to be taken continuously
once DMARDs work, NSAIDs can be stopped
-steroids (not preferred)
methotrexate onset time
improvement of sx in 4-6 weeks
often used in early RH (start asap to lessen permanent effects)
how to dx OA
-bone scans, CT, MRI (can show early changes)
-xrays help in staging progression
-no biomarkers
-ESR will be normal (unless synovitis present)
-synovial fluid will be clear yellow & no sign of inflammation
labs OA vs RH
OA: neg RF, neg anti CCP & normal ESR & CRP
RH: pos RF, pos anti CCP & elevated ESR & CRP
who to consult for OA
-rheumatologist
-physical therapist
-occupational therapist
-nutritionist
OA drug therapy
-mild to mod: acetaminophen (if lacking signs of inflammation)
-if not relived by above or signs of inflam: NSAIDs
-if problem w/ GI but need NSAIDs: celecoxib
RH collaborative care
-rest (but physical fitness should be maintained)
-8 to 10 hrs of sleep + a nap
-exercise (even if painful bc not exercising makes it worse)
-ROM
-hand & finger splinting
-PT & OT
-heat (max 20 mins), cold (max 10-15 mins)
-good dietary habits
-biofeedback
lupus CM
-joint pain (earliest sx): fingers, wrists & knees
-dont feel well for awhile but dont know why
-polyarthralgia in the morning
-pain & stiffness moves through body and usually doesn’t affect both sides in the same way
-joints are swollen and warm
-photosensitivity + butterfly rash
-lupus nephritis w/n 5yrs & lupus cerebritis
-anemia, thrombocytopenia, mild leukopenia
-unexplained fever
-extreme fatigue
-raynauds phenomenon
lupus medication therapy
very individualized
-hydroxychloroquine (almost all will be on) + NSAIDs & short term steroids (<7.5 mg/d)
-if severe, intensive immunosuppressants (methotrexate) & high dose steroids to halt issue injury
lupus CM (objective cues)
-unusual hair loss
-edema in legs or around eyes
-ulcers of mouth & nose
-pleurisy & pericarditis
-diff concentrating, confusion
-depression
-headaces
-seizures
-finger deformities
dx of gout
-elevated uric acid
-24 hr urine collection (can tell what is cause)
-synovial fluid tested (gold standard but rarely done)
recs for people w/ gout
1) lose wt
2) take meds
3) eat recommended diet
kcal restriction, inc protein, complex carbs & dec sat fat + dec sugar sweetened bevs & avoid flare foods like fatty meals, organ rich foods, beer and distilled spirits
gout drug therapy
acute: colchicine (dramatic relief within 12-24 hrs) & NSAIDs
prophylactic: allopurinal (2-6wk onset)
Describe what causes Closed-angle glaucoma:
Also known as Angle-closrure
It is a narrow angle between the cornea and iris that prevents aqueous humor from being reabsorbed.
The aqueous humor is unable to get to the trabecular meshwork
How does closed-angle glaucoma patient present?
The patient has a painful red eye that must be treated within 24 hours or blindness may be permanent.
EMERGENCY
The alternative option if drug therapy does not work for a patient with Chronic Open-angle glaucoma is called:
Argon Laser Trabeculoplasty (ALT) (Out-patient procedure) ; The laser hits the damaged trabecular meshwork and opens the outflow channels
The initial therapies you will have in the ED with acute angle-closure glaucoma consist of:
Beta-blocker topical agent
Carbonic anhydrase inhibitor (acetazolamide)- PO
Miotic eye drops (helps lower the IOP by constricting the pupils)
GOAL: immediate relief!
Further care associated with Acute Angle-Closure Glaucoma that a patient may experience in the ED includes:
aggressive treatment of pain and nausea
measures to avoid activity and to keep calm
apply a patch or covering to the affected eye
Prepare for iridotomy once the IOP is stabilized
Iridotomy
Punching holes in the iris that allows for the aqueous humor to get to the other side
Acute Interventions for a patient with Acute Angle-closure Glaucoma
Quick and appropriate drug therapy
For acute pain:
If light sensitive = darken room (after the eye is fully constricted)
Apply cool compress to forehead
Find a quiet/private environment
Keep the patient and family informed
Ensure support and teaching for patient/family
diagnostics for benign hyperplasia
History & physical
Digital rectal exam (enlarged, hard & smooth)
Urinalysis and C&S (inc risk of urinary retention and hydronephrosis)
Serum creatinine (elevated)
Serum prostate-specific antigen (PSA)
what are the irritative symptoms of the clinical manifestations of BPH
Due to inflammation or infection.
Nocturia (often first symptom), frequency, urgency, dysuria, bladder pain & incontinence
lower UTI
invasive therapies for BPH
Transurethral Resection of the Prostate (TURP): Gold standard surgical treatment
Removal of prostate tissue
Resectoscope inserted into urethra
What test is the only way to distinguish among the various forms of viral hepatitis?
antibody antigen testing
HIDA scan
nuclear medicine is injected IV and is taken up by hepatocytes and excreted into bile to show patency of common bile duct and ampulla
What are 3 things that should be done before and ERCP and all endoscopies
NPO x 8 hrs
Consent form signed
Administer sedation
what is the most common complication of an ERCP
pancreatitis
What are 2 things nurses should do after an ERCP
Check VS (looking for manifestations of perforation or infection)
Check for return of gag reflex (usually returns in 2-4 hours. Do this before giving fluid intake)
ERCP visualizes and assess the
pancreatic, hepatic, and common bile duct
Before a liver biopsy procedure:
Check ____
Ensure patient’s blood is ____ and ______
_____ is signed
Baseline ____ _____
Explain- ___ ____ ____ ______ ___ ____ ____
1) coags (INR and PT)
2) typed and cross-matched
consent
3) vital signs
4) hold breath after expiration when needle inserted
Liver Function Tests (LFTs): abnormal
ALT
AST
Alk Phos
Bilirubin (total) _________
conjugated (direct)
unconjugated (indirect)
Serum Ammonia (NH3) _________
Serum Protein (total) _________
Serum albumin __________
Prothrombin time (PT) _________
ALT: increases
AST: increases
Alk Phos: increases
Bili: increases
NH3: increase
Pro: decreases
Albumin: decreases
PT: prolonged
What are some nursing teaching points about hepatitis for patients and family?
Maintain sanitation; personal hygiene (wash hands after toileting).
Drink water treated by water purification system.
If traveling to underdeveloped country, drink bottled water only. Avoid food washed in tap water; avoid ice.
Don’t share bed linens, eating utensils, or drinking glasses
Do not share needles for injection, body piercing or tattooing
Don’t share razors, nail clipper, toothbrushes
Use condom during sexual activity (or abstain)
Cover cuts/sores with bandage
If infected, never donate blood, body organs or other body tissues
hepatitis diet
When it comes to nutrition for hepatitis patients, there is no special diet.
Patients need a well-balanced, adequate calorie diet.
If fat content not tolerated (due to decreased bile production), decreased fat
Vitamin supplements, esp. B-complex and Vitamin K
What is the process with Endoscopic Sclerotherapy & Variceal Banding
Varices injected with a sclerosing agent via a catheter.
Varices may also be managed by endoscopic variceal ligation (banding):
Involves application of a small “O” bands around the base of the varices to decrease the blood supply to the varices.
Patient unaware of bands; cause no discomfort
What is a Transjugular intrahepatic portal-systemic shunt (TIPS)
Non-surgical procedure used to control long-term ascites & reduce variceal bleeding
Early manifestations of Cirrhosis (6)
Insidious
Weight loss
Weakness
GI disturbances
Anorexia, N/V, flatulence, change in bowel habits
Hepatomegaly
RUQ pain/palpable liver
Late manifestations of cirrhosis
Jaundice
decreased serum albumin & PT (2 proteins manufactured by liver)
Portal hypertension
Ascites
Splenomegaly
Spider angiomas & caput
medusae
Esophageal & anorectal varices
Hepatic encephalopathy
Asterixis (liver flap)
End stage Hepatic encephalopathy nursing care
Restrict protein intake (20-40 g/daily); otherwise ↑ calorie (particularly carbohydrates)
Control GI bleeding
(another source of protein)
Avoid constipation
(constipation ↑’s ammonia in feces)
Medications: Lactulose (“titrate to 2-4 stools/day”) & Neomycin
Assess EMV (Glasgow Coma Scale) regularly
Safety precautions
Patient & family teaching
Nursing Care in patients with Cirrhosis
Measures to manage ascites/excess fluid volume:
Assess/measure abdominal girth*
Sodium restriction/possibly fluid restriction
Diuretics (Spironolactone & loops)
Fluid removal:
Paracentesis*
Portosystemic shunt (TIPS)*
IV albumin
Patient & family teaching
balloon tamponade
used for active bleed in esophageal varices emergency by placing a tube with an attached balloon through the nasal passage and inflating the balloon against the varices placing pressure on the bleeding
Bleed precautions to manage with varices (10)
Monitor platelets, PT, PTT
Assess oral cavity
Monitor for ecchymosis, purpura & petechiae
Protect from falls
No ASA, alcohol, spicy foods, bulky foods; no injections
Avoid vigorous nose-blowing, straining w/ BM’s
Stool softeners
Soft toothbrush; avoid rectal temps/enemas
Apply pressure to any bleeding x 5 mins
Patient teaching r/t above
What are the teaching points of PERT enzyme replacement
Take pancreatic enzymes before or with meals and snacks.
Sometimes ordered to administer with antacid or H2 blockers; (because a decreased pH inactivates drug).
Tell the patient to swallow the tablets without chewing to minimize oral irritation.
Avoid lip/skin contact with enzymes. (Wipe lips prn after ingesting.)
Mix the powder form in applesauce or fruit juice at patient’s request.
Do not mix enzyme preparations in protein-containing foods.
Do not crush enteric-coated preparations.
What are some considerations with patient weight in chronic pancreatitis
Weight loss can be significant:
Sometimes a candidate for TPN
If taking PO, may need up to 4000 to 6000 calories/day to maintain weight.
How do patients need to manage nutrition to prevent exacerbation of chronic pancreatitis
Eat bland, low-fat, high-protein, high carbohydrate meals; avoid gastric stimulants, such as spices.
Eat small meals and snacks high in calories.
T/F Hyperglycemia should be monitored in acute pancreatitis
True, due to impact to the exocrine function
Clinical manifestations in acute pancreatitis
pain
N/V
low grade fever/ leukocytosis
jaundice
paralytic ileus
cullen’s & turner’s sign
hypovolemia/tachycardia
increase serum amylase & lipase
increase serum triglycerides
decrease in serum calcium
look back at the whys
