Exam 2 Flashcards
What parts of the body does Lupus (SLE) typically affect?
skin, muscle, lining of lungs, heart, nervous tissue, kidneys
What is the main determining factor for diagnosing SLE?
immunologal disorders: positive LE prep= anti-DNA antibody or antibody to small nuclear antigen
or false positive serologic tests for syphilis
Pharm. treatment for SLE.
NSAIDS, anticoagulants (Warfarin), anti-malarial meds (Plaquenil), corticosteroids (prednisone, salumedrol), immunosupressive meds (imuran, cytoxan)
Identify the clinical manifestations of RA.
inflammation of connective tissues of the joints: insidious onset, pain, stiffness, limitation of motion, inflammation, symmetrical, sm joints of hands and feet
- rheumatoid nodules
- Sjorgen’s syndrome
- felty syndrome
Identify the pharm treatment of RA and goals for patients.
Immunosupressants (Methotrexate), Sulfasaline, antimalarial (hydroxychloroquine
goals= satisfactory pain relief, min. loss of functional ability, maintain pos. self image
What CN is effected with trigeminal neuralgia and what are the s/s?
CN 5- motor and sensory branches affected: abrupt onsets of excruciating pain, twitching, grimacing, and frequent blinking during an attack
Identify treatment options for trigeminal neuralgia.
Carbamazepine (tegretol), gabapentin, Phenytoin (dilantin)- seizure meds help stabilize the nerve and decrease pain
- have pt chew on good side
- monitor food temps
What nerve does Bell’s palsy affect and what is the result?
CN VII (facial)=inability to move one side of the face
What is the treatment for a pt with bell’s palsy?
moist heat on face, gentle massage, Prednisone, antiviral (if HSV), protect eye, pain relief, social support ( drooling and tearing is embarrassing)
Describe Guillian-Barre Syndrome.
AI inflammatory disease that affects the PNS.
- demyelination of the axons= interrupted conduction, varying motor weakness and paralysis, “crawling skin”
- it’s aggressive and starts from the feet up.
- often proceeded by immune system stimulation: virus, surgery, trauma, viral immunizations, HIV
Describe the nursing management of a pt with GBS.
manage pain, eye care, rehab, maintain adequate ventilation
Correlate the clinical manifestations of spinal cord injury (SCI) with the level of injury eg. (C1 -T5)
T6 and above= decr. SNS response= bradycardia, peripheral vasodilation, hypotension, relative hypovolemia
T12 or below or spinal shock= bowel is areflexic and sphincter tone is decreased
Differentiate between spinal and neurogenic shock.
Spinal shock= temporary; initial inflammatory & circulatory effect on cord
Neurogenic shock= loss of vasomotor tone; blood pools in extremities; decreased BP and pulse
dentify treatment modalities and nursing care for patients with a SCI.
immediately post injury: maintain patent airway, adequate ventilation, and circulating blood volume, and preventing secondary damage
nonoperative stabilization= stabilize the injured spinal segment and decompression through traction or realignment
surgical therapy= may be beneficial with cord compression or the neurologic disorder progresses; or w/ compound fracture, penetrating wounds, or bone fragments—> decompression laminectomy by ant. cervical and thoracic approaches with fusion, post. laminectomy with the use of acrylic wire mesh and fusion, and insertion of stabilization rods for the correction and stabilization of thoracic deformities
drug therapy= high rise Mehtylprednisolone for improved motor strength within 8 hr of injury
corticosteroids= moderate benefit
vasopressors (Dopamine) used as adjuncts in acute phase
Understand the importance of neurovascular assessment for an injured extremity.
w/ muskuloskeletal trauma, casts or constrictive dressings, poor positioning, and the physiologic responses to the traumatic injury can cause nerve or vascular damage
it should consist of a peripheral vascular assessment (color, temp, cap refill, pulses, edema) and a peripheral neurologic assessment (sensation, motor function, and pain)
Describe the difference between strains and sprains and understand nursing care for each.
strain= overstretching/tear in the tendon, muscle, or it’s fascial sheath
sprain= overstretching/tear in the ligament
usually self-limiting, with full function returning in 3-6 wks
-health promotion- warm up before exercise followed by stretching; strength, balance, and endurance exercise are important
acute intervention= stop the movement/exercise 2) ice compresses 3) compressing extremity 4) elevate 5) analgesia as necessary
ice 20-30 min
Differentiate between open and closed reduction and traction and complications and nursing management for each.
closed= nonsurgical, manual realignment of bone fragments; traction and counter traction applied
open= correction of alignment though surgical incision— usually includes internal fixation with screws , wires, pins, plates, rods, or nails
traction= application of pulling force to an injures or diseased part of the body in posit directions
skin traction is short ter, treatment (48-72 hr) until skeletal traction or surgery is possible
Understand the pathophysiology, clinical manifestations, collaborate care and nursing management of a patient with compartment syndrome
Elevated intracompartmental pressure within a confined myofascial compartment compromises the neurovascular function of tissues within the space
-causes capillary perfusion to be reduced
- two causes: 1) decreased compartment size resulting from restrictive dressings, splints, casts, excessive traction, or premature closure of facia
2) incr. compartment contents r/t bleeding, edema, chemical response to snakebite, or IV infiltration
- When arterial flow is compromised ischemia results–> muscle and nerve cells destroyed over time –> fibrotic tissue replaces healthy tissue –> contracture, disability, and loss of function occurs
- prevention is key —> ischemia can occur within 48 hours after onset
- 6 p’s: paresthesia, pain, pressure, pallor, paralysis, pulselessness
Assess pain and urine output–> myoglobin released from damaged cells obstructs the renal tubule’s and can result in acute tubular necrosis= dark reddish brown urine
surgical decompression a.k.a. fasciotomy maybe necessary
Understand the pathophysiology, clinical manifestations, collaborate care and nursing management of a patient with a hip fracture.
refers to fracture of the proximal third of the femur or can be intracapsular fractures
manifestations= external rotation muscle spasm, shortening of affected extremity, sever tenderness and pain in fracture site
collaborative care- initially immobilized with Buck’s traction to relieve muscle spasm until surgery
pre-op: hypertsn, DM, HF, pulmonary disease, and arthritis are chronic problems that may complicate surgery
post-op: monitor VS, I&O, resp. status, assess neurovascular status,
complications with femoral neck fracture= nonunion, avascular necrosis, dislocation, and degenerative arthritis
Muscular dystrophy
a group of genetically transmitted diseases characterized by progressive symmetric wasting of skeletal muscles with increasing disability without neurologic involvement.
• The types of MD differ in the groups of muscles affected, age of onset, rate of progression, and mode of genetic inheritance.
• Since there is no curative treatment, the goal of care is to preserve mobility.
Understand the etiology, clinical manifestations, diagnostic studies, collaborative care and nursing management of patients with RA
genetic predisposition; - HLA
manifestations= fatigue, weight loss, anorexia, stiffness
dx: pos. RF, ESR and C-reactive protein are indicators of active inflammation, anti-CCP for early detection
tx: methotrexate- se= bone marrow suppression and hepatotoxicity; Sulfasalazine and antimalarial hydrochloroquine (retinopathy may occur and progress after discnt’d for mild-mod disease—> rapidly absorbed and relatively safe; corticosteroids for exacerbations and severe disease
Understand the etiology, clinical manifestations, diagnostic studies, collaborative care and nursing management of patients with OA.
many factors linked to the development of the disease
manifestations= joint pain- worse w/ movement and relieved with rest, stiffness, crepitation, asymmetrical, deformed
dx: bone scan, CT, MRI, x-ray
tx: balance of rest and activity, heat (for stiffness) and cold applications, weight-reduction, acetaminophen
