AH II Exam IV Flashcards
Traction patient teaching
we expect some clear drainage around pins (but not new red drainage)
traction weight should never touch the floor
if pt has mm spasms, the weight is too heavy and they need to be realigned
What can you do to make a cast more comfortable?
petaling
What can you do to make a cast more comfortable?
petaling
Complication of cast care
compartment syndrome
How heavy can skin traction for hip and femur fractures be?
5-10 lbs
How heavy can skeletal traction be?
15-30 lbs
What are considerations for skeletal traction?
it impairs patient mobility
it involves pin care
What are considerations for skeletal traction?
it impairs patient mobility
it involves pin care
Rheumatiod vs Osteoarthritis labs/S&S
Rheumatoid: women 35-45, bilateral Sjogren's Syndrome: dry mouth, dry eyes, dry vagina (+) Rheumatoid arthritis (RA) factor (+) A/A Increased ESR
Osteo: women over 65, unilateral joint stiffness in the morning pain in weight bearing joints Heberden's nodes (DIP) Bouchard's nodes (PIP)
How should you position a hip fracture patient?
maintain ABDuction (Buck’s traction?)
Pt teaching for osteoarthritis (regarding a medication)
Glucosamine is a medication for osteoarthritis; do NOT take if you are diabetic, pregnant or breastfeeding
How should you position a hip replacement patient?
maintain ABDuction (Buck’s traction?)
What is a priority for a post op hip replacement patient?
early ambulation
When are abductor pillows NOT recommended after a hip replacement?
if the surgery was anteriorly approached (we want to avoid hyperextension of the hip)
When are abductor pillows NOT recommended after a hip replacement?
if the surgery was anteriorly approached (we want to avoid hyperextension of the hip)
Should a joint replacement patient increase activity?
not unless prescribed
What precautions are particularly important for a joint replacement patient?
bleeding precautions
What tx is specific to a knee replacement?
Continuous passive ROM device
Gout hallmark sign:
big toe pain
What labs must be assessed when giving allopurinol for Gout?
uric acid
Gout dx labs
> 6.5 mg/dL uric acid
750 mg uric acid in a 24 hour urine
Gout diet recommendations:
reduce purine (sardines, organ meats)
S&S of osteoporosis:
height loss
back pain
fractures
kyphosis
Risk factors for osteoporosis:
postmenopausal women
steroids (reduce bone density)
Osteoporosis meds
fosamax*** - reduces bone breakdown
Evista
Boniva - c water
Reclast - check creatinine
Salmon calcitonin
Lupus S&S
Hallmark: butterfly rash
Alopecia
Arthritis
Anemia
hematuria
pleural effusion
raynaud’s
seizures
What aids in the diagnosis of lupus (lab)?
ANA antibodies
What organs does lupus affect?
kidneys
skin
joints
Lupus patient teaching
avoid crowds, wear sunglasses/hat
What labs will be elevated if lupus is affecting the kidney’s?
creatinine and BUN
S&S of Lyme Disease:
Hallmark: bullseye (erythema migrans)
Stage I:
fatigue
H/A
bullseye
Stage II:
neuro cx
lyme carditis
Stage III:
arthritis
memory loss
Pt teaching for Lyme disease:
DEET up
flush the tick if you find one and wash the area with alcohol
S&S of fibromyalgia:
weeklong pain fatigue memory loss morning stiffness depression noise sensitivity
Nursing priority for fibromyalgia:
help them sleep and reduce their pain
Pt teaching for fibromyalgia:
avoid caffeine
What levels does allopurinol affect in the body?
it reduces uric acid AND blood sugar
What instructions should you give with allopurinol?
drink 2-3 liters of water/day
What should the nurse expect to find after a tick bite (NOT Lyme disease)?
bright red rash with vesicles
What should someone do to avoid a tick bite?
avoid dense undergrowth when in a wooded area
How does someone get Lupus (SLE)?
it is an autoimmune condition from genetics/hormones
What is a major teaching point with SLE?
they should NOT become pregnant
What are some considerations for Fosamax (for osteoporosis and Paget’s)
take on an empty stomach 30 minutes BEFORE eating or drinking and remain upright for 30-60 minutes after they’ve taken it
What are the 4 bacterial sin infections we should know?
Folliculitis & Furuncles
Carbuncle & Cellulitis
What is folliculitis? S&S?
Razor burn on the thighs, beard and scalp
S&S: hair may grow through the infection
NO scarring
What are furuncles? S&S?
boils in the hair, neck and armpit - worsening of folliculitis
pus filled nodules
YES scarring
What is a carbuncle?
an abscessed furuncle (boil)
involves subcutaneous tissue
What is cellulitis?
red/hot/painful skin caused by staph or strep infection
Which skin infections are viral?
Herpes Simplex 1&2 Herpes Zoster (Shingles) Acne Dermatitis Psoriasis
How does someone get Herpes I? Herpes II?
I - reoccurring cold sore (kissing/shared glass)
II - genital herpes (sex)
S&S of Herpes I vs. Herpes II?
I - lips tingling/burning
II - painful perineum and vesicles
How do you detect Herpes Zoster (Shingles)?
Tzanck test
S&S of Shingles?
unilateral pain and itching then an eruption
older patients can get postthuerpetic neuralgia (burning pain with eruption)
S&S of Shingles?
unilateral pain and itching then an eruption along a nerve line
fever
malaise
What can older patients with Shingles get?
postthuerpetic neuralgia (burning pain with eruption)
How do we treat Herpes Zoster (Shingles)?
isolate the patient and keep them away from kids
give Acyclovir and a chicken pox vaccine if they’ve never had it
What are the types of pediculosis (lice)?
Pediculosis capitis (head) Pediculosis corporis (body) Pediculosis pubis (crabs)
Who should NOT take Kwell?
pt with hx of seizures
Who might take Kwell?
pt with lice (pediculosis)
pt with scabies
How do we manage Scabies?
a contagious mite disease
Kwell
Elimite
WASH THOSE BEDDINGS
How do you manage psoriasis flare ups non pharmacologically?
UV light
Vitamin D
How do you know you’re experiencing a psoriasis flare up?
the area becomes thick
How can you tell if psoriasis tx is working?
- skin is thinner
- reduced scales
What is the hallmark sign of a basal cell carcinoma?
pearly colored with a crater
What skin tumor is usually malignant?
actinic keratosis
What is a seborrheic keratosis?
a mole that is part of the normal aging process
How should you assess for a malignant melanoma?
A - asymmetry B - border irregularity C - color changes D - diameter > 6mm E - evolution
What are the different types of glaucoma?
Open angle - most common type, gradual onset
Angle closure - sudden onset
S&S of glaucoma?
Open angle - slowly reduced visual field, H/A, eye itching, blurred vision
Late: halos, loss of peripheral vision, glasses do NOT help
Angle closure - iris moves forward and presses on cornea, SUDDEN ONSET, pain, dilated pupils, red conjunctiva
surgical tx of glaucoma?
- argon laser trabeculoplasty
- trabeculectomy - creates new outlet for fluid outflow
- for acute closure - iridotomy to prevent scarring of the iris/cornea
What IS glaucoma?
increased pressure in the eyeball
What should you do with a pt who punctured their eye?
do not remove object, put on a protective shield
What should you do with a pt who spilled chemicals in their eye?
immediate eye irrigation
Post op care for eye surgery
- elevate HOB
2. avoid straining/valsalva, sneezing, coughing, lifting weights (increased IOP)
Post op care for cataract surgery
antibiotics/steroids as ordered
eye is NOT patched
Mild itching and bloodshot eyes are normal
Pain and N/V is NOT normal
tx for conjunctivitis
hand washing
antibiotic eyedrops
warm compresses
pt eduction for conjunctivitis
prevent cross contamination
WASH YAH HANDS
detached retina S&S
floaters
flashing lights “shooting stars”/”lighting”
blurred vision
detached retina priority tx
protect the eye
position to decrease IOP
S&S of otitis media
pain fever drainage (any color) bulging eardrum non-permeant hearing loss
What is a consideration for an older client with cerumen ear?
reduce the pressure
What is a consideration for an older client with cerumen ear?
reduce the pressure
What are the types of hearing loss?
Conductive - physical obstruction
Sensorineural - cochlea/8th cranial nerve/brain defect
Mixed - profound and total
Post op management for hearing loss procedures:
antiseptic soaked gauze in the ear canal
pt positioned supine with operative ear facing up for 12 hours after surgery
Post op care for otosclerosis :
pain and anti vertigo drugs
damage to cranial nerves, vertigo N/V are common
What surgery is related to otosclerosis?
Stapedectomy - a prosthesis that corrects hearing loss
Hearing improvement may not occur until 6 weeks after surgery
What cranial nerve does acoustic neuroma impact? S&S? Tx?
8th (benign tumor)
tinnitus
vertigo
hearing loss
requires surgical removal
S&S of Meniere’s Disease:
tinnitus
unilateral hearing loss
vertigo for several days
How do we fix Meniere’s Disease?
nonsurgical - slow head movements, salt and fluid restrictions, stop smoking, diuretics, nicotinic acid, allergy meds, vomiting meds, benzo .
surgical - last resort; labyrinthectomy or endolymphatic decompression (Meniett device) - hearing in affected ear is sacrificed most of the time
How is HIV transmitted?
semen
blood
rectal fluid
What should HIV/AIDs patients not share?
razors
What is the only test that confirms HIV (+) status?
Western blot
What is the diagnostic criteria for AIDS?
T cells drop below 200
What is the priority tx for HIV/AIDS?
prevent opportunistic infection
At what levels do opportunistic infections occur?
when CD4 count is less than 200
What is the most effective tx for preventing opportunistic infections in patients with HIV/AIDS?
antiretrovirals
What is the prophylactic tx of HIV?
PrEP (Truvada)
daily dose
SE: N/V, dizzy, H/A
goal is PREVENTION NOT TX
What is HIV PEP?
post-exposure prophylaxis within 72 hours
month long course that is not 100% effective
SE: nausea
most commonly used for exposed healthcare workers
