Activity And Rest

Question 0

How is restless leg syndrome treated?

Answer 0

Symptoms may be eased by change in diet and exercise.
Non-Pharmacologically by massage, heat or cold therapy, and maintaining a regular sleeping pattern.
Severe RLS- medication may be helpful.
Dopamine agonists ropinirole (equip) which act on the neurotransmitter dopamine in brain.
Anticonvulsants, such as gabapentin (neurontin) or anti-seizure drugs.
Opioids- ocycodone
Benzodiazepines- Valium

Question 1

How is obstructive sleep apnea treated?

Answer 1

Lifestyle changes: loose weight, avoid alcohol or sedative at bedtime. Avoid sleeping on back may help
The cpap: continuous positive airway pressure. Keep windpipe open during sleep and prevents episodes of blocked breathing.

Question 2

How is insomnia treated?

Answer 2

Mild-‘practice good sleep hygiene.
Severe- sleeping pills. Rapid, short acting drugs may help you avoid drowsiness the following day. Avoid using over the counter meds., b/c undesired side effects and loose their effectiveness over time.
Chronic- first treat underlying conditions or health problems that are causing insomnia. Behavioral therapy
Ambien

Question 3

If sleep apnea is left untreated:

Answer 3

Can cause heart arrhythmias, heart failure, high blood pressure, stroke

Question 4

Stages of sleep

Answer 4

NREM sleep is the ,arrest percentage of sleep time, aprox 75-80%. NREM is divided into three stages
Stage 1 is the begging of sleep, with slow eye movements,mand is a transition phase from wakefulness to sleep.,1-7 min. The person can be easily awakened
Stage 2- sound sleep. Heart rate slows down and body temp drops. 10-15 min
Stage 3- deep or slow wave-sleep. It is the deepest stage of sleep. This stage lasts 20-40 min. Dreaming is more common in this stage than in other stages of NREM sleep, although not as common as in REM sleep.
REM sleep- accounts for 20-25% of sleep. REM sleep follows NREM sleep. In a healthy adult REM sleep occurs 4-5 times during a period of 7-8 hrs of sleep. This stage is considered paradoxic because the brain waves resemble wakefulness. rEM sleep is thought to be important for memory consolidation and is the period when the most vivid dreaming occurs.

Question 5

Osteoarthritis

Answer 5

Insidious onset , aka degenerative joint

Cartilage is a natural shock absorber, cushions the ends of bones and reduces friction in healthy joints.

Question 6

Treatment for osteoarthritis

Answer 6

Balance rest and activity
Joint immobilization should not be prolonged due to stiffness
Cane, walker, crutches
Heat therapy is helpful for stiffness.
Cold therapy is used to reduce inflammation.
Weight reduction (diet, exercise) low impact exercise- swimming, walking or bicycling, yoga and massage
Training with light weights can help by stretch ending the muscles that surround the joint.

Question 7

Drug treatment for osteoarthritis- over the counter anti inflammatory meds

Answer 7

Also pain relieving creams- aspercreme contains salicylic acid help with pain relief and decrease in joint inflammation.
Nutritional supplements
-glucosamine, chondrotin sulfate (essential for the formation of cartilage and synovial fluid)
Glucocorticoids (prednisone)
Intraarticular -directly into joint space
Also surgery

Question 8

Rheumatoid arthritis is a systemic inflammatory disease

Answer 8

The joints are usually the most affected, however the inflammation can affect organs And other areas of body too.
Usually affects joints symmetrically (on both sides equally) may initially begin in a couple of joints only, and most frequently attacks the wrists, hands, knees, ankles.

Question 9

Rheumatoid arthritis is a disease that

Answer 9

Waxes and wanes (comes and goes)

Question 10

RA

Answer 10

The synovial membrane becomes inflamed, resulting in the production of excessive synovial fluid.
Synovitis- synovial membrane also thickens with inflammation

Question 11

Gout-

Answer 11

The presence uric acid crystals causes inflammatory response.
Gouty arthritis
Recurrent attacks of painful joint inflammation

Question 12

Gout

Answer 12

Formation of tophi

Lumps of collected crystals under the skin, in the joints and in bone.

Question 13

Gout

Answer 13

Kidney stones- uric acid stones

Gout nephropathy- impaired kidney function, obstruction

Question 14

Uric acid level, gout

Answer 14

Purines are nucleotide bases found in plant and animal cells.
Example- adenine, guanine are two of the four bases in DNA
Purines are metabolized to uric acid
Increased uric acid production
Failure of the kidneys to filter out uric acid.

Question 15

Causes of gout

Answer 15

Although purine rich foods do not cause gout alone, they can trigger and exacerbation of the disease.

Question 16

Diagnosis of gout

Answer 16

Serum uric acid levels >6mg/dl
24 hr urine to test for levels of uric acid elimination
Symptoms

Question 17

Drug therapy

Answer 17

NSAIDs
Colchicine- prevents activation and migration of neutrophils, though to mediate some gout symptoms.
Decreases uric acid crystal formation
Colchicine and probenecid (combo drug) probenecid helps increase the excretion of uric acid in the urine.
Allopurinol- reduces the production of uric acid by inhibiting the biochemical reactions immediately preceding its formation.

Question 18

Adduction

Answer 18

Bringing limbs into body- adding to

Question 19

Abduction- lifting arms away from body

Abductor pillow after total hip replacement -no internal rotation of hips, do not want toes to pint to each other.

Answer 19

Abduction- lifting arms away from body

Abductor pillow after total hip replacement -no internal rotation of hips, do not want toes to pint to each other.

Question 20

Goals/ outcomes for patient with nursing diagnosis of impaired mobility

Answer 20

Sit up at side of bed and stand with walker using TTWB toe touch weight bearing on affected led with assistance of physical therapist with minimal discomfort. (Rates pain at 4 or below)
Log roll every 2 hrs as ordered
Consume 100% of meals
Drink 700 mil fluid from 0700 to 1300
Skin remains fully intact from head to toe

Question 21

What cause contractures?

Answer 21

Brain or nervous system disorders
Scarring after traumatic injury
Inherited disorders
Nerve damage
Reduced use- immobility 
Scarring after traumatic injury or burn

Question 22

Treatment of contracture

Answer 22

Manual treatment options for contractures include: stretching, heat therapy and exercise. Together these techniques can restore mobility and build critical muscle.
Mechanical treatment options- CPM continuous passive motion machines to increase mobility.

Question 23

Treatments for contracture

Answer 23

Casting or splinting- used to provide a consistent stretch of the affected soft tissue. After the initial cast or splint is removed, a serious of casts is used to make a regular adjustment in order to improve mobility over time.

Surgery, manipulation of the joint as the patient is under general anesthesia.

Muscle relaxants- some, Valium

Question 24

Osteoporosis

Answer 24

Chronic, progressive loss of bone mass
Occurs when bones lose mineral, such as calcium, more quickly than the body can replace them.
Bone resorption exceeds bone deposition.
Bones become thinner and less dense, so that even a minor bump or accident can cause serious fractures.

Question 25

Kyphosis

Answer 25

Successive compression or crush fractures, in which there is a collapse of affected bone, May lead to increased curvature of the spine.
Aka dowagers hump

Question 26

Osteoporosis prevention

Answer 26

Vitamin d 400-800 IU(with little sun exposure)
Physical activity- strengthens bones
Prevention of fractures- home safety

Question 27

Osteoporosis drug therapy prevention

Answer 27

Estrogen replacement therapy

May be used as a preventative therapy after menopause along with calcium supplement.

Question 28

Calcitonin

Answer 28

Secreted by thyroid gland inhibits osteoclasts which break down bone.

IM, sub Q, and intanasal(snort it up)

Question 29

Drug therapy for osteoarthritis

Answer 29

Biphosphonates- alendronate (fosamax), risedronate (Actonel)
Inhibit osteoclasts bone resorption and increase total bone mass

Question 30

Fosamax and Actonel

Answer 30

Take in am with full glass of water
Empty stomach/ 30 min. Prior to eating
Do not lie down after, because of GI irritation

Question 31

Drug therapy for osteoporosis

Answer 31

Raloxifene (evista)
Estrogen receptor modulator
Mimic effects of estrogen on the bone without stimulating breast or uterine tissue