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NUR 211 Krissa > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Teaching points for clients with RA

A
  • Stick to treatment plan
  • Report S/S of infection
  • Keep current on vaccines
  • No live vaccines
  • Assist with referrals
  • ID safety hazards in the home
  • proper use of assistive adaptive devices
  • Energy conservation techniques (pace activities)
  • Keep up follow up appointments with provider
  • Sit in high, straight back chair
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2
Q

What do you need to teach a RA patient about taking their steroids?

A

Take them at the same time every day

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3
Q

Patients taking NSAID’s and immunosuppressants’s increased risk for what?

A

infection

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4
Q

Patients with RA on a current therapy plans should stay utd on all __________ and be aware not to take _______________.

A

Vaccines
live vaccines

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5
Q

Proper use of assistive devices can help RA patients do what?

A

Preserve independence and protects joint function

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5
Q

What kinds of referrals should RA patients have?

A

PT/OT
infectious disease specialist

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6
Q

RA patients should be taught ___________ ___________ techniques. This helps ______________, __________________, _____________

A

energy conservation
preserves energy
manages fatigue
protects joints

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7
Q

RA patients should be encouraged to have a consistent _____________ program

A

exercise

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7
Q

A consistent exercise program can help an RA patient with what?

A

mantains joint function, mobility, and decreases stiffness

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7
Q

The importance of what needs to be stressed to RA patients so that their disease can be monitored and the effectiveness of the treatment can be determined

A

Follow up appointments
Lab work

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8
Q

Follow up appointments are important for an RA patient because?

A

monitor disease process, and treatment effectiveness

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9
Q

RA patients need to be taught that they need to plan extra time for ADL’s especially in the morning because of what?

A

morning stiffness

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10
Q

This medication class is used to treat RA.
Can be given PO, IM, or IV.
Supresses inflammation.
Patients taking this med need their blood sugar and electrolytes monitored.
Pt needs to be monitored for S/S of bleeding.
This medication needs to be taken at the same time each day

A

Glucocorticoid - Prednisone

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11
Q

Prednisone medication class

A

Glucocorticoid

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12
Q

This medication class is used to treat RA.
Can be given PO
Used for pain relief and decreases inflammation
Do not take with alcohol
Monitor clotting times

A

NSAIDs

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13
Q

Celebrex medication class

A

NSAIDs

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14
Q

This medication class is given to treat both cancer and RA
Can be given PO, SQ, IM, IV
Alters inflammatory response, decreases inflammation, and slows disease progression.
Pt needs to be assessed for bleeding
No IM injections
Monitor CBC (plt)

A

Disease-Modifying Antirheumatic Drugs or DMARDs

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15
Q

Methotrexate’s medication class

A

DMARD’s

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16
Q

This medication class is used to treat RA
Can be given PO, PR, and IV
Given for pain relief
Monitor LFT & PT
Avoid alcohol
Assess for rash

A

Analgesics

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17
Q

Medication class for Acetaminophen

A

Analgesics

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18
Q

Clinical manifestations of RA

A
  • Joint Pain & Swelling
  • Erythema
  • Morning stiffness
  • Low grade temp
  • Fatigue
  • Anorexia & Weight loss
  • Anemia
  • Joint Deformities
  • Decreased ROM
  • Disability
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19
Q
  • Joint Pain & Swelling
  • Erythema
  • Morning stiffness
  • Low grade temp
  • Fatigue
  • Anorexia & Weight loss
  • Anemia
  • Joint Deformities
  • Decreased ROM
  • Disability

these are all clinical manifestations of what?

A

RA

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20
Q

Clinical manifestation of SLE

A
  • Butterfly rash
  • Weakness/fatigue
  • Photosensitivity
  • Joint Pain
  • Oral or nasal ulcers
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21
Q

Erythema of the palms.
Dry, scaly, raised rash on face or upper body

A

butterfly rash

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22
Q

If a patient with SLE is complaining of weakness or fatigue the nurse should assess for what?

A

Anorexia, anemia, weight loss

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23
Q

People with SLE should be mindful of wearing sunscreen because of what?

A

photosensitivity

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24
Q

A patient with SLE is complaining of oral and/or nasal ulcers. What should the nurse assess the patient for?

A

Anemia
Leukopenia
Thrombocytopenia

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25
Q

Raynaud’s Phenomenon

A

excessive response to cold. Fingers turn pale then turn blue. Common in SLE patients

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26
Q

Labs to monitor for SLE patients

A

ANA
ESR
CRP
BUN/Creatinine
Urinalysis

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27
Q

A positive ANA indicates what?

A

presence of an autoimmune disease

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28
Q

An elevated ESR indicates what?

A

inflammation

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29
Q

An elevated CRP indicates what?

A

inflammation

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30
Q

An elevated BUN and Creatinine indicate what?

A

Kidney involvement

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31
Q

A urinalysis testing positive for protein indicates what?

A

kidney involvement

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32
Q

Expected labs when testing for Lupus

A

ANA - Positive
ESR - Inflammation
CRP - Inflammation

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33
Q

Important education for SLE patients

A
  • Disease process
  • Use sunscreen daily
  • Activity prioritization and energy conservation
  • Staying UTD on vaccinations…NO LIVE VACCINES
  • Avoid oral contraceptives
  • Use mild soap to cleanse skin and hair, and avoid harsh perfumed substances
  • Encourage a high vitamin and high iron diet. Also, high protein kidney diet IF NO KIDNEY INVOLVEMENT
  • Assist in referrals
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34
Q

What do SLE patients need to be taught about the disease process?

A

how to manage the disease and prevent complications

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35
Q

How can SLE patients manage fatigue?

A

Activity prioritization and energy conservation

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36
Q

How to manage an SLE patient’s risk for infection

A

Stay UTD on vaccines

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37
Q

Can patients on therapy plans for RA, lupus, SCA, or leukemia receive live vaccines?

A

NO

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38
Q

D/t the risk of hypercoagulability what should SLE patients avoid?

A

Oral contraceptives

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39
Q

Oral contraceptives should be avoided by SLE patients because of?

A

Hypercoagulability

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40
Q

To prevent irritation, what kind of soap should be used by SLE patients? Harsh what should be avoided?

A

mild soap
Harsh perfumed substances

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41
Q

What kind of diet should be encouraged for SLE patients?

A

High vitamin
Hight iron diet
High protein kidney only if no kidney involvement

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42
Q

A high protein kidney diet should only be encouraged for SLE patients if what?

A

there is no kidney involvement

43
Q

Example of Immediate, Rapid allergic RXN

A

Allergic Rhinitis, Asthma, Anaphylaxis

44
Q

Allergic Rhinitis, Asthma, and Anaphylaxis are all examples of what type of allergic reaction

A

Immediate, Rapid allergic reaction

45
Q

Examples of Cytotoxic allergic RXN

A

Transfusion reaction, myasthenia Gravis

46
Q

A transfusion reaction and myasthenia gravis are examples if what kind of reaction

A

Cytotoxic Allergic RXN

47
Q

Examples of an immune complex allergic reaction (AG-AB)

A

Rheumatoid Arthritis, Lupus

48
Q

Rheumatoid Arthritis and Lupus are examples of what type of reaction?

A

An immune complex allergic reaction (AG-AB)

49
Q

Examples of a delayed allergic reaction

A

Poison Ivy
TB Skin Test

50
Q

A rash from poison ivy or a TB skin test are examples of what type of allergic reaction?

A

Delayed allergic reaction

51
Q

An example of a continuous stimulation allergic reaction

A

Grave’s disease

52
Q

Grave’s disease is an example of what type of allergic reaction?

A

Continuous stimulation allergic reaction

53
Q

Acronym for hypersensitivity reactions

A

ICIDC - “I Can’t I Don’t Care”
Type I: I - Immediate, Rapid allergic RXN
Type II: C - cytotoxic RXN
Type III: I - immune complex RXN
Type IV: D -delayed RXN
Type V: C -continuous stimulation RXN

54
Q

Step-by-step what to do for a patient having a RXN to antineoplastic medications

A
  1. Assess respiratory status
  2. Stop the medication
  3. Contact PCP
  4. Administer supplemental oxygen
  5. Maintain IV with NS
  6. Raise clients feet and legs, if not contraindicated to help maintain BP
  7. Administer prescribed emergency medications
  8. Monitor VS
  9. Document the event, actions taken, and clients response
55
Q

Before administering an epi-pen be sure to check what?

A

the expiration date

56
Q

Teaching points on education for HIV/AIDS patients

A
  • Small frequent nutrient-dense foods
  • No raw meats
  • No fruits with multiple bumps that are hard to thoroughly clean
  • Foods that require little chewing to conserve energy
57
Q

Teaching points for hypersensitivity rxn

A
  • Educate pts regarding potential causes in the environment and ways to avoid exposure to the allergen
  • Antihistamines
  • Decongestants
  • Steroids may be needed
  • Beta antagonist bronchodilators may aid in easing respiratory distress
  • Educate the patient regarding the S/S of initial S/S of initial RXN: rash, itching
  • Carry Epi-pen if needed
  • Medical bracelet if needed
58
Q

What to do if someone suspects an HIV/AIDS infection

A

a thorough physical assessment, determine any clinical manifestations that are present, as well as obtain a sexual history to determine if a client describes any high-risk behaviors or other risk factors that would indicate virus transmission had occurred

59
Q

Lab values used to diagnose/monitor the disease progression of HIV/AIDS

A

ELISA
HIV Virus Antibodies
CD4+ count
Viral load

60
Q

Tests used to diagnose HIV/AIDS

A

ELSIA
HIV Virus Antibodies

61
Q

Tests used to test the effectiveness of treatment for HIV/AIDS

A

HIV VIrus Antibodies
CD4+
Viral load

62
Q

What is an Enzyme-Linked Immunosorbent Assay test?

A

ELSIA
Tests for the presence of antibodies. Presence of antibodies = presence of HIV

63
Q

This is a test that can be done on oral fluids or blood. If test falls between 0.9-1.0 pt should be rechecked later. It could mean the body hasn’t had enough time to make antibodies

A

HIV Virus Antibody Test

64
Q

HIV Virus Antibody test

A

This is a test that can be done on oral fluids or blood. If test falls between 0.9-1.0 pt should be rechecked later. It could mean the body hasn’t had enough time to make antibodies

65
Q

As the CD4+ count rises what happens to the viral load

A

decreases

66
Q

As the viral load increases what happens to the CD4+ count?

A

decreases

67
Q

If a patient viral load test comes back undetectable. Does that mean they are cured?

A

No

68
Q

Unprotected sex
IV Drug use
Blood transfusions
occupational exposure
Pregnant as breastfeeding women
Older population

are all risk factors for what?

A

HIV/AIDS

69
Q

Risk factors for HIV/AIDS

A

Unprotected sex
IV Drug use
Blood transfusions
occupational exposure
Pregnant as breastfeeding women
Older population

70
Q

Priority nursing interventions r/t leukemia (AML)

A
  • only perform essential activities
  • neutropenic precautions
  • bleeding precautions
  • allow adequate rest during care
  • administer blood products as ordered
  • prepare client for transplant if indicated
  • educate regarding home care measures, referrals for home care
  • Modify CV risk factors - avoid crossing legs, restrictive clothing, smoking cessation, implement DVT prophylaxis
71
Q

Post bone aspiration, how long should pressure be held at the puncture site?

A

5-10 mins

72
Q

How long should a dressing stay on after a bone aspiration?

A

24 hours

73
Q

What kind of dressing needs to be used to cover the puncture site after a bone aspiration?

A

a sterile dressing

74
Q

the patient is experiencing:
bruising
petechiae
ecchymosis
nose bleeds
bleeding gums
black tarry stools
hematuria

what do you suspect?

A

thrombocytopenia

75
Q

S/S of thrombocytopenia

A

bruising
petechiae
ecchymosis
nose bleeds
bleeding gums
black tarry stools
hematuria

76
Q

Most common type of leukemia in children

A

ALL

77
Q

methotrexate antidote

A

leucovorin

78
Q

Nursing interventions for thrombocytopenic patients

A

· Implement bleeding precautions

· Minimize blood loss from lacerations and venipunctures

· Avoid IM injections

· Avoid rectal temps, enemas, suppositories, and douches

· Provide safe environment

· Use minimal inflation when assessing BP

· Minimize blood draws

Instruct pt to avoid sexual intercourse

79
Q

What medications increase cell counts

A

Colony stimulating factor medications

80
Q

This type of CS factor Promotes differentiation of granulocytes and macrophages

A

Granulocyte Macrophage CS Factor

81
Q

CS Factor that Stimulates bone marrow to make more blood cells

A

Granulocyte CS Factor

82
Q

CS Factor that Stimulates bone marrow to make more RBC’s

A

Erythropoietin

83
Q

This type of CS Factor stimulates bone marrow to make more platelets

A

Thrombopoietic Growth Factors

84
Q

This type of leukemia causes Mostly lymphocytes in bone marrow. Onset < 15 y/o. Most common in children

A

Acute Lymphocytic Leukemia ALL

85
Q

This type of leukemia causes Mostly lymphocytes in bone marrow. Onset > 50 y/o

A

Chronic Lymphocytic Leukemia CLL

86
Q

This type of leukemia causes Mostly myeloblasts in bone marrow. Onset 15-39 y/o

A

Acute Myeloid Leukemia AML

87
Q

This type of leukemia causes Mostly granulocytes in bone marrow. Onset in 4th decade

A

Chronic Myeloid Leukemia CML

88
Q

Foods to help increase Iron intake

A

· Red meat

· Spinach

· Broccoli

· Peas

· Beats

· Dried Beans

· Iron fortified cereals and bread

· Cream of wheat

· Increase citrus fruit consumption

89
Q

Teachings with iron supplements

A

PO IM IV

S/E: N/V/D/C Abd discomfort

If giving IV iron supplements, VS should be monitored frequently throughout the infusion d/t risk of possible cardiac side effects

90
Q

Clinical manifestations of IDA

A

· Hypoxia

· Fatigue

· Pallor

· Tachycardia

· Tachypnea

· ShOB

· Fissures in corner of mouth

· Painful swelling of the tongue

· Smooth shiny tongue

· Spoon shaped fingernails

PICA

91
Q

· Hypoxia

· Fatigue

· Pallor

· Tachycardia

· Tachypnea

· ShOB

· Fissures in corner of mouth

· Painful swelling of the tongue

· Smooth shiny tongue

· Spoon shaped fingernails

PICA

These are all clinical manifestations of what?

A

IDA

92
Q

What is PICA

A
  • People who have depleted iron stores ingest non-nutritive substances such as:
    -Paint
    -Dirt
    -Clay
    -Ice

Laundry Starch

93
Q

Risk factors for Vitamin B-12 deficiency

A

· Older Adults

· GI Resections

· Gastric Bypass

· Autoimmune disease Dx

· Crohn’s Dx

· Celiac Dx

Long term PPI use

94
Q

Clinical manifestations of Vitamin B-12 Deficiency

A

· Spinal chord degeneration

· Peripheral neuropathy

· Altered Mental Status

· Depression

· Visual Changes

· Tachycardia

· ShOB

· Dizziness

· Fatigue

· Severe Pallor

· Weight loss

· Gait/Balance issues

Glossitis

95
Q

· Spinal chord degeneration

· Peripheral neuropathy

· Altered Mental Status

· Depression

· Visual Changes

· Tachycardia

· ShOB

· Dizziness

· Fatigue

· Severe Pallor

· Weight loss

· Gait/Balance issues

Glossitis

clinical manifestations of what?

A

Vitamin B-12 deciciency

96
Q

Clinical manifestations of folic acid deficiency

A

· Confusion & Disorientation d/t decreased hgb levels

· Assess for ShOB

· Tachypnea

· Oxygen saturation

· Tachycardia

· Pallor

· Fatigue

· Heart sounds

· Assess LOC

Confusion

97
Q

· Confusion & Disorientation d/t decreased hgb levels

· Assess for ShOB

· Tachypnea

· Oxygen saturation

· Tachycardia

· Pallor

· Fatigue

· Heart sounds

· Assess LOC

Confusion

these are all clinical manifestations of what?

A

Folic acid deficiency

98
Q

Foods to treat folic acid deficiency

A

· Asparagus

· Broccoli

· Brussel Sprouts

· Avocado

· Leafy Green

· Liver

· Citrus Fruit

· Dried beans

· Fortified grains nuts

Folic acid supplements

99
Q

What medication class is hydroxyurea? what is it used for?

A

· Antimetabolite, PO, Prevents formation of sickle shaped blood cells, which makes sickle cell crisis less likely to occur. Can help reduce acute chest syndrome

100
Q

Side effects of hydroxyurea

A

· Stomach pain, N/V/D, constipation, loss of appetite, leukemia, skin cancer, blood vessel damage, lung disease, anaphylaxis

101
Q

Nursing interventions for Hydroxyurea

A

Wear gloves when handling
wash hands before and after handling
keep emergency equipment at bedside
pregnant/breastfeeding women cannot take

102
Q

Factors that can lead to sickle cell crisis

A

· Cold temperatures

· Restrictive or tight clothing

· High altitudes/depressurized planes

· Dehydration

· Overexertion

Pregnancy

103
Q

Pallitive care

A

· Specialized care

· Focuses on pain relief, symptoms, and stress associated with severe illness

104
Q

Hospice care

A

· Care of a client with a terminal illness.

· Expected to live less than 6 months

105
Q

Neutropenic precautions

A

· Frequent hand washing or the use of alcohol-base hand sanitizer by the patient and others coming into contract with the patient

· Avoid crowds. If the neutropenic patient must go out a mask is indicated.

· Avoid obviously sick people, small children, and pets while neutrophil count is low

· Wash all raw fruits and vegetables well before eating. It is best to avoid fruits such as raspberries and blackberries that have little bumps and ridges and cannot be washed well

· Monitor temperature daily, and contact the HCP if temp is greater than 100.4 F (38 C)

· For fevers, rigors, and obvious clinical manifestations of illness, seek immediate medical attention. Rapid treatment with IV ABX is crucial to prevent sepsis and death

· There should not be any live plants or cut flowers in the home environment because they breed bacteria and mold. This is also includes while the patients are in the hospital

· Avoid standing water in appliances such as humidifiers because this also breeds mold and bacteria

· If patients started on prophylactic ABX, antiviral, and antifungal therapies, stress the importance of taking prescribed medications daily and completing the entire course of ABX

· A patient with neutropenia requires a private room if hospitalized

· Avoid rectal temperatures, suppositories, and enemas because of the normal bacteria in the rectum that could enter the bloodstream if there is rectal trauma associated with these interventions.

106
Q

Bleeding Precautions

A

· Soft bristle toothbrush or gauze to clean teeth. No flossing

· Use electric razor

· Encourage the use of shoe or slippers when OOB

· Maintain a clutter free environment to minimize bruising

· Use a stool softener daily to decrease constipation and straining during BM

· Avoid rectal thermometers, suppositories, enemas, and vaginal douches

· Avoid sexual intercourse when plt count is low

· Do not blow nose

· When using knife is necessary, make sure the blade is sharp. More force is required for dull knives

· If a laceration occurs, apply direct pressure and/or ice for no less than 5 mins until bleeding stops

Procedures such as IM injections, arterial sticks, and peripheral blood draws should be kept to a minimum

107
Q

S/S of cerebellar Dysfunction

A

· D – Dysdiadochokinesia (inability to preform rapid movements)

· A – Ataxia (no coordination in gait/posture)

· N – Nystagmus

· I – Intention Tremor

· S – Slurred or staccato speech

· H – Hypotonia/Heel-shin test (floppy)

108
Q

S/S of neuroleptic malignant syndrome

A

· Fever

· Respiratory distress

· Tachycardia

· Seizures

· Diaphoresis

· HTN or Hypotension

· Pallor

· Tiredness

· Severe muscle stiffness

· Loss of bladder control

109
Q

S/S of anemia

A

· Fatigue

· Pallor

· ShOB

· Dizziness/lightheadedness

· Irregular heartbeat

· Chest pain

· Cold hands/feet

NUR 211 Krissa (16 decks)

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