Exam 1 Flashcards
Teaching points for clients with RA
- 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
What do you need to teach a RA patient about taking their steroids?
Take them at the same time every day
Patients taking NSAID’s and immunosuppressants’s increased risk for what?
infection
Patients with RA on a current therapy plans should stay utd on all __________ and be aware not to take _______________.
Vaccines
live vaccines
Proper use of assistive devices can help RA patients do what?
Preserve independence and protects joint function
What kinds of referrals should RA patients have?
PT/OT
infectious disease specialist
RA patients should be taught ___________ ___________ techniques. This helps ______________, __________________, _____________
energy conservation
preserves energy
manages fatigue
protects joints
RA patients should be encouraged to have a consistent _____________ program
exercise
A consistent exercise program can help an RA patient with what?
mantains joint function, mobility, and decreases stiffness
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
Follow up appointments
Lab work
Follow up appointments are important for an RA patient because?
monitor disease process, and treatment effectiveness
RA patients need to be taught that they need to plan extra time for ADL’s especially in the morning because of what?
morning stiffness
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
Glucocorticoid - Prednisone
Prednisone medication class
Glucocorticoid
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
NSAIDs
Celebrex medication class
NSAIDs
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)
Disease-Modifying Antirheumatic Drugs or DMARDs
Methotrexate’s medication class
DMARD’s
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
Analgesics
Medication class for Acetaminophen
Analgesics
Clinical manifestations of RA
- Joint Pain & Swelling
- Erythema
- Morning stiffness
- Low grade temp
- Fatigue
- Anorexia & Weight loss
- Anemia
- Joint Deformities
- Decreased ROM
- Disability
- 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?
RA
Clinical manifestation of SLE
- Butterfly rash
- Weakness/fatigue
- Photosensitivity
- Joint Pain
- Oral or nasal ulcers
Erythema of the palms.
Dry, scaly, raised rash on face or upper body
butterfly rash
If a patient with SLE is complaining of weakness or fatigue the nurse should assess for what?
Anorexia, anemia, weight loss
People with SLE should be mindful of wearing sunscreen because of what?
photosensitivity
A patient with SLE is complaining of oral and/or nasal ulcers. What should the nurse assess the patient for?
Anemia
Leukopenia
Thrombocytopenia
Raynaud’s Phenomenon
excessive response to cold. Fingers turn pale then turn blue. Common in SLE patients
Labs to monitor for SLE patients
ANA
ESR
CRP
BUN/Creatinine
Urinalysis
A positive ANA indicates what?
presence of an autoimmune disease
An elevated ESR indicates what?
inflammation
An elevated CRP indicates what?
inflammation
An elevated BUN and Creatinine indicate what?
Kidney involvement
A urinalysis testing positive for protein indicates what?
kidney involvement
Expected labs when testing for Lupus
ANA - Positive
ESR - Inflammation
CRP - Inflammation
Important education for SLE patients
- 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
What do SLE patients need to be taught about the disease process?
how to manage the disease and prevent complications
How can SLE patients manage fatigue?
Activity prioritization and energy conservation
How to manage an SLE patient’s risk for infection
Stay UTD on vaccines
Can patients on therapy plans for RA, lupus, SCA, or leukemia receive live vaccines?
NO
D/t the risk of hypercoagulability what should SLE patients avoid?
Oral contraceptives
Oral contraceptives should be avoided by SLE patients because of?
Hypercoagulability
To prevent irritation, what kind of soap should be used by SLE patients? Harsh what should be avoided?
mild soap
Harsh perfumed substances
What kind of diet should be encouraged for SLE patients?
High vitamin
Hight iron diet
High protein kidney only if no kidney involvement
A high protein kidney diet should only be encouraged for SLE patients if what?
there is no kidney involvement
Example of Immediate, Rapid allergic RXN
Allergic Rhinitis, Asthma, Anaphylaxis
Allergic Rhinitis, Asthma, and Anaphylaxis are all examples of what type of allergic reaction
Immediate, Rapid allergic reaction
Examples of Cytotoxic allergic RXN
Transfusion reaction, myasthenia Gravis
A transfusion reaction and myasthenia gravis are examples if what kind of reaction
Cytotoxic Allergic RXN
Examples of an immune complex allergic reaction (AG-AB)
Rheumatoid Arthritis, Lupus
Rheumatoid Arthritis and Lupus are examples of what type of reaction?
An immune complex allergic reaction (AG-AB)
Examples of a delayed allergic reaction
Poison Ivy
TB Skin Test
A rash from poison ivy or a TB skin test are examples of what type of allergic reaction?
Delayed allergic reaction
An example of a continuous stimulation allergic reaction
Grave’s disease
Grave’s disease is an example of what type of allergic reaction?
Continuous stimulation allergic reaction
Acronym for hypersensitivity reactions
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
Step-by-step what to do for a patient having a RXN to antineoplastic medications
- Assess respiratory status
- Stop the medication
- Contact PCP
- Administer supplemental oxygen
- Maintain IV with NS
- Raise clients feet and legs, if not contraindicated to help maintain BP
- Administer prescribed emergency medications
- Monitor VS
- Document the event, actions taken, and clients response
Before administering an epi-pen be sure to check what?
the expiration date
Teaching points on education for HIV/AIDS patients
- 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
Teaching points for hypersensitivity rxn
- 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
What to do if someone suspects an HIV/AIDS infection
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
Lab values used to diagnose/monitor the disease progression of HIV/AIDS
ELISA
HIV Virus Antibodies
CD4+ count
Viral load
Tests used to diagnose HIV/AIDS
ELSIA
HIV Virus Antibodies
Tests used to test the effectiveness of treatment for HIV/AIDS
HIV VIrus Antibodies
CD4+
Viral load
What is an Enzyme-Linked Immunosorbent Assay test?
ELSIA
Tests for the presence of antibodies. Presence of antibodies = presence of HIV
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
HIV Virus Antibody Test
HIV Virus Antibody test
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
As the CD4+ count rises what happens to the viral load
decreases
As the viral load increases what happens to the CD4+ count?
decreases
If a patient viral load test comes back undetectable. Does that mean they are cured?
No
Unprotected sex
IV Drug use
Blood transfusions
occupational exposure
Pregnant as breastfeeding women
Older population
are all risk factors for what?
HIV/AIDS
Risk factors for HIV/AIDS
Unprotected sex
IV Drug use
Blood transfusions
occupational exposure
Pregnant as breastfeeding women
Older population
Priority nursing interventions r/t leukemia (AML)
- 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
Post bone aspiration, how long should pressure be held at the puncture site?
5-10 mins
How long should a dressing stay on after a bone aspiration?
24 hours
What kind of dressing needs to be used to cover the puncture site after a bone aspiration?
a sterile dressing
the patient is experiencing:
bruising
petechiae
ecchymosis
nose bleeds
bleeding gums
black tarry stools
hematuria
what do you suspect?
thrombocytopenia
S/S of thrombocytopenia
bruising
petechiae
ecchymosis
nose bleeds
bleeding gums
black tarry stools
hematuria
Most common type of leukemia in children
ALL
methotrexate antidote
leucovorin
Nursing interventions for thrombocytopenic patients
· 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
What medications increase cell counts
Colony stimulating factor medications
This type of CS factor Promotes differentiation of granulocytes and macrophages
Granulocyte Macrophage CS Factor
CS Factor that Stimulates bone marrow to make more blood cells
Granulocyte CS Factor
CS Factor that Stimulates bone marrow to make more RBC’s
Erythropoietin
This type of CS Factor stimulates bone marrow to make more platelets
Thrombopoietic Growth Factors
This type of leukemia causes Mostly lymphocytes in bone marrow. Onset < 15 y/o. Most common in children
Acute Lymphocytic Leukemia ALL
This type of leukemia causes Mostly lymphocytes in bone marrow. Onset > 50 y/o
Chronic Lymphocytic Leukemia CLL
This type of leukemia causes Mostly myeloblasts in bone marrow. Onset 15-39 y/o
Acute Myeloid Leukemia AML
This type of leukemia causes Mostly granulocytes in bone marrow. Onset in 4th decade
Chronic Myeloid Leukemia CML
Foods to help increase Iron intake
· Red meat
· Spinach
· Broccoli
· Peas
· Beats
· Dried Beans
· Iron fortified cereals and bread
· Cream of wheat
· Increase citrus fruit consumption
Teachings with iron supplements
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
Clinical manifestations of IDA
· Hypoxia
· Fatigue
· Pallor
· Tachycardia
· Tachypnea
· ShOB
· Fissures in corner of mouth
· Painful swelling of the tongue
· Smooth shiny tongue
· Spoon shaped fingernails
PICA
· 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?
IDA
What is PICA
- People who have depleted iron stores ingest non-nutritive substances such as:
-Paint
-Dirt
-Clay
-Ice
Laundry Starch
Risk factors for Vitamin B-12 deficiency
· Older Adults
· GI Resections
· Gastric Bypass
· Autoimmune disease Dx
· Crohn’s Dx
· Celiac Dx
Long term PPI use
Clinical manifestations of Vitamin B-12 Deficiency
· Spinal chord degeneration
· Peripheral neuropathy
· Altered Mental Status
· Depression
· Visual Changes
· Tachycardia
· ShOB
· Dizziness
· Fatigue
· Severe Pallor
· Weight loss
· Gait/Balance issues
Glossitis
· 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?
Vitamin B-12 deciciency
Clinical manifestations of folic acid deficiency
· Confusion & Disorientation d/t decreased hgb levels
· Assess for ShOB
· Tachypnea
· Oxygen saturation
· Tachycardia
· Pallor
· Fatigue
· Heart sounds
· Assess LOC
Confusion
· 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?
Folic acid deficiency
Foods to treat folic acid deficiency
· Asparagus
· Broccoli
· Brussel Sprouts
· Avocado
· Leafy Green
· Liver
· Citrus Fruit
· Dried beans
· Fortified grains nuts
Folic acid supplements
What medication class is hydroxyurea? what is it used for?
· Antimetabolite, PO, Prevents formation of sickle shaped blood cells, which makes sickle cell crisis less likely to occur. Can help reduce acute chest syndrome
Side effects of hydroxyurea
· Stomach pain, N/V/D, constipation, loss of appetite, leukemia, skin cancer, blood vessel damage, lung disease, anaphylaxis
Nursing interventions for Hydroxyurea
Wear gloves when handling
wash hands before and after handling
keep emergency equipment at bedside
pregnant/breastfeeding women cannot take
Factors that can lead to sickle cell crisis
· Cold temperatures
· Restrictive or tight clothing
· High altitudes/depressurized planes
· Dehydration
· Overexertion
Pregnancy
Pallitive care
· Specialized care
· Focuses on pain relief, symptoms, and stress associated with severe illness
Hospice care
· Care of a client with a terminal illness.
· Expected to live less than 6 months
Neutropenic precautions
· 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.
Bleeding Precautions
· 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
S/S of cerebellar Dysfunction
· 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)
S/S of neuroleptic malignant syndrome
· Fever
· Respiratory distress
· Tachycardia
· Seizures
· Diaphoresis
· HTN or Hypotension
· Pallor
· Tiredness
· Severe muscle stiffness
· Loss of bladder control
S/S of anemia
· Fatigue
· Pallor
· ShOB
· Dizziness/lightheadedness
· Irregular heartbeat
· Chest pain
· Cold hands/feet
